Rider's Personal Information
Last Name *
First Name *
Birthday *
Age *
Complete Mailing Address *
Email Address *
Mobile Number *
No. of years Cycling *
Longest Single Day Cycling Distance *
Longest Consecutive Days Cycling Distance *
Please select your preferred pace *
Profession / Business *
Shirt Size *
Shirt Quantity *
Jersey size *
Jersey Quantity *
Emergency Contact Name *
Blood Type
Relationship *
Emergency Contact Number *
waiver of liability
By submitting this form, I, agree for myself, and anyone entitled to act on my behalf to waive and release any and all rights I may have held against Rotary International, Rotary Philippines, the members and officers of the Rotary Club of Cebu, officers of Rotary District 3860, sponsors, and organizers of this event for any and all injuries and/or losses sustained by me as a result of participating in this event.

I further give consent to use my name and/or likeness for publicity and promotional purposes without liability or obligation to me and that I commit to train for this event in order to complete the ride.
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