ROTARY CLUB OF LAKE IN THE HILLS

Registration Form
BENEFIT MOTORCYCLE RIDE
Sunday, September 7, 2014
Come enjoy a beautiful day while helping support a club project the International projects for the club.
The net proceeds raised will be directed for use by the International Committees for the Rotary Club of
Lake in the Hills to continue participation in humanitarian projects in less fortunate areas of the world.
....

Name: ________________________________________ Address: _______________________________________

City: ______________________ Zip Code:__________ Phone: _______________________________________

Email: ________________________________________ Have you participated in a motorcycle charity ride
Before? Yes No

Waiver: I understand and am aware that there are dangers and risks involved in riding a motorcycle in a group such as this
Benefit Ride. These dangers and risks include damage, injury and/or death. Knowing and appreciating fully these dangers and
risks, I the undersigned hereby waive, release and forever discharge the Rotary Club of Lake in the Hills, the proceed
recipient, members of the organizing committee, sponsors, supporters, volunteers, and all others associated with the event of
and from all manner of actions, cause of action, suits, debts, claims and demands whatsoever arising from or in connection
with the Rotary Club of Lake in the Hills Benefit Motorcycle Ride and associated events. I assume full responsibility for injury
or damage arising as a result of the participation association with the Rotary Club of Lake in the Hills Benefit Motorcycle
Ride and for my passengers. This waiver also includes a model release for photographs taken and video recordings made
while participating in the above activities.

Signed: ________________________________________ Date: __________________________________________


PLEASE READ CAREFULLY The following are the registration fees

_____ Package 1 (Pre-Registered Biker Plus T-Shirt)= $35

_____ Package 2 (Pre-Registered Biker & Passenger and Two T-Shirts) = $45

_____ Package 3 (Biker day of run registration) = $40

_____ Package 4 (Biker & Passenger day of run registration) = $50

Shirt Size(s): ___ S ___ M ___ L ___ XL ___ XXL

(Shirts are only guaranteed for those pre-registered)


Payment options: Mail check or money order payable to:
Rotary Club of Lake in the Hills (in memo section write Benefit Ride)
P.O. Box 7386
Algonquin, IL 60102
Please include this registration form with your check or money order

Registration MUST be received by September 1 to qualify for pre-registration rates
Questions: Call Jim Wales, Rotary Club of Lake in the Hills Benefit Motorcycle Ride at 847-815-9459
Schedule

9 am 10:30 am Woodstock
Harley Davidson, Rt. 47 just south
of Rt. 14

10:30 am Kickstands up Ride
(Maps Provided)

End ride at Barbara Key Park
Barbecue Included (Hot dogs &
Hamburgers)