2019 RAGBRAI Support & Transportation Form
The Waver and Payment must be received March 31, 2019
Email address *
Note
Rider must be a bike burlington member and registered with RAGBRAI in order to camp with Bike Burlington. Member ship application and dues can be submitted online as well.
2018 Bike Burlington Dues (If paying by check include in envelope) *
Choose t-shirt size *
How many RAGBRAI's have you been on? *
Your answer
Type of Bike: *
If riding a Tandem, please list other Rider:
Your answer
What type of support? *
(Daily Riders only) indicate number of day(s)
Your answer
(Daily Riders Only) Select days
Paying online or sending a check (payment must be received by March 31st for discount) *
First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
zip *
Your answer
Phone *
Your answer
Birthday *
MM
/
DD
/
YYYY
Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
Emergency Contact Relationship *
Your answer
COVENANT NOT TO SUE:
The undersigned, for and in consideration of the privilege of participating in events and activities organized and sponsored by Bike Burlington, Inc., hereby covenants and agrees not to sue Bike Burlington, Inc., it’s officers or agents for damages which may be incurred by the undersigned arising out of the undersigned’s participation in such activities or events and caused by the negligence of Bike Burlington, Inc., it’s officers and agents
Rider (or parent or guardian signing for child under 18) Type full name *
Your answer
Check Box to confirm Signature *
Required
If Rider is under 18
please list the accompanying riders information. (rider must be traveling with Bike Burlington)
Accompanying riders Name *
Your answer
Accompanying riders Phone *
Your answer
Please include additional comments here. Thank you!
Your answer
A copy of your responses will be emailed to the address you provided.
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