RELEASE OF LIABILITY AND INDEMNITY AGREEMENT-GROUP RIDES
Rider Information
Which Bingham Cyclery Shop is your ride starting at? *
Rider First Name *
Your answer
Rider Last Name *
Your answer
Email Address *
Your answer
Primary Phone Number *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Driver's License Number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Is the Rider 18 years or older *
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