Chai Cyclist Registration

Event Date: Sunday, June 3, 2012
Registration Deadline: Friday, May 25, 2012

When you register for Bike the Forest, you commit to raising a minimum of $180 for Bike the Forest. Your credit card secures your registration. All contributions made in your honor and received by Monday, June 4 are counted towards your commitment. On June 4, your credit card will be charged the difference between $180 and all received contributions.

After you register, you will be able to create your own personal web page. We encourage you to tell your story as you ask your friends, family, and colleagues for their support. Sponsors can donate to your ride through your web page.

All Chai Cyclists are eligible for great prizes. Raise $1,000 and receive a digital camera. Raise $2,000 and receive a Flip video camera.

Questions? Call us at 847 763-1818 or contact us by email.

Registration Information

Single Cyclist - Raise $180
Team of 5 Cyclists - Raise $750
Team of 10 Cyclists - Raise $1500

Personal Information

Team Name or Full Name: *

Birthdate: *

Gender: *

Male Female

If under 18, person you are registering with:

Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Email Address: *

Drive Information

T-shirt Size: *

Emergency Contact Name: *

Emergency Contact Phone: *

Choose your username and password. You will need it to view your web page, and see who has sponsored you for this event.

Username: *

Password: *

Re-Type Password: *

Credit Card Information

Card Type: *

Card Number: *

Exp. Month: *

Exp. Year: *

Security Code: *

This is the 3 or 4 digit number printed on the back signature panel.
It is on the front of the card for American Express.

Commitment

Waiver and Release

I wish to participate in the Bike the Forest program to help raise awareness and funds to support the non-profit mission of Chai Lifeline, Inc. I understand that while training for and participating in this event, I will be using public streets and facilities where many hazards exist and I am aware of and appreciate the risks that may result. I am also aware that accidents may occur during this event, which could result in serious injury or death. I am voluntarily participating in this event with knowledge of the dangers involved and I agree to accept all risks of injury or death.

In consideration for being permitted to participate in this event to support Chai Lifeline, I agree to assume all risks and to release, hold harmless and covenant not to sue Chai Lifeline, Inc., Camp Simcha, Bike the Forest event team members or captain(s), and any designated beneficiaries, sponsors, officials, participating clubs, communities, organizations, friends of the event, and all other government or public entities including, but not limited to, the Department of Transportation and affiliated organizations and all their respective directors, officers, agents, employees and members (collectively, "the releases"), from any claim, loss or liability that I may have arising out of my participation in and training for the event, including bodily injury, death or property damage, whether caused by negligence or carelessness of the releases or otherwise.

I intend by the Waiver and Release in advance, and to waive my rights and to discharge all the releases from all claims, losses, or liabilities for death, bodily injury or property damage that I may have, or which may hereafter accrue to me, as a result of my participation in this event, even though that liability may arise from negligence or carelessness on the part of the releases, from dangerous or defective property or equipment owned, maintained or controlled by them or because of the possible liability without fault. I understand and agree that the Waiver and Release is binding on my heirs, assigns and legal representatives.

I am physically capable of completing this event. If I am aware of or under treatment for any physical infirmity, ailment or illness, my medical care provider knows of and has approved my participation in this event. I will maintain personal health insurance while training for and participating in the event. I acknowledge 
that I, and I alone, am entirely responsible for my personal health and safety, and the personal property I bring with me.

I understand that all donations processed by Chai Lifeline, Inc. are non-refundable and non-transferable even if I don't participate in the event. 
I understand that my name, photograph, voice or likeness may be used by Chai Lifeline, Camp Simcha, Bike the Forest, and their sponsors, beneficiaries, licensees, affiliates and employees. I consent to and authorize, in advance, such use and waive all rights of privacy I have in connection therewith. And I understand that I will not benefit financially from any use thereof. 
I have carefully read this Waiver and Release and fully understand its contents. I am aware that by accepting this Waiver and Release, I am waiving legal rights and knowing this, I accept it of my own free will.

I understand and agree to the waiver and release

Please wait a moment while we process your request.
Do not hit the "Register" button more than once!

Chai Cyclist Registration

Event Date: Sunday, June 3, 2012 Registration Deadline: Friday, May 25, 2012

Event Date: Sunday, June 3, 2012
Registration Deadline: Friday, May 25, 2012