Rider's Personal Information
Last Name *
Your answer
First Name *
Your answer
Birthday *
Your answer
Age *
Your answer
Complete Mailing Address *
Your answer
Email Address *
Your answer
Mobile Number *
Your answer
No. of years Cycling *
Your answer
Longest Single Day Cycling Distance *
Your answer
Longest Consecutive Days Cycling Distance *
Your answer
Please select your preferred pace *
Profession / Business *
Your answer
Shirt Size *
Shirt Quantity *
Your answer
Jersey size *
Jersey Quantity *
Your answer
Emergency Contact Name *
Your answer
Blood Type
Your answer
Relationship *
Your answer
Emergency Contact Number *
Your answer
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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