Registration Form
2016 Bicycle Fitness Ride for Scholarship on Saturday, May 7, 2016
Entry fee : April 1, 2016 - April 30, 2016 - $30.00

May 1, 2016 - May 6, 2016 - $35.00

May 7, 2016 - $40.00

After completing this form, please be sure to finish your registration by paying your entry fee via PayPal at the BUY NOW button on our website www.fbmandrmj.org! Your registration will not be complete unless you pay your registration fee for the event.
Name *
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Team Name (if applicable)
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Address *
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City *
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State *
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Zip Code *
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Email *
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Phone *
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T-Shirt Size *
Route *
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In consideration of the acceptance of this entry, I hereby for myself, my heirs, executors, administrator and assigns release and discharge the Fonnie B. Murrill & Ruth M. Jones Scholarship Foundation, Riverside Bicycle Shop, the City of Kinston, their agents, employees and sponsors whose facilities, services and products are being used for this event, from any claims for damages suffered by me as a result of my participation in or traveling to or from said event to be held on Saturday, May 7, 2016. I specially release and discharge the said promoters and sponsors and all participants, whose facilities are being used for this event, etc. from all injuries or damages arising from or contributed to any physical impairment or defect I may have, whether latent or patent, and agree that they are under no obligation to provide physical examination or other evidence of any fitness to participate in such event, the same being my responsibility. I also give permission for the free use of my name and picture in any broadcast, telecast or other written account of the event. I understand that helmets are required for riders under the age of 16 and recommended for riders 16 and over.
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