WRHC Bike-N-Brunch 2019 Registration Form
Thank you for signing up for WRHC Radio Harbor Country's 2019 Bike-N-Brunch! Please submit this form to complete your registration.

Date: Sunday, June 2, 2019
Registration @ 8:30 am / Ride @ 9:00 am EST
Ride will depart from 10232 Wilson Road, New Buffalo MI 49117, 2 miles east of Four Winds Casino.

- Please register by June 1, 2019.
- Registration /waiver forms are required for each rider.
- Ride is limited to first 150 registrants, Adults - $50, Kids under 12 - $30
- Register via Paypal or credit card on our website radioharborcountry.org or...
- Mail check payable to WRHC, P.O. Box 101, Three Oaks, MI 49128
- Ride occurs rain or shine.
- Bike-n-Brunch communications: bikenbrunch.wrhc@gmail.com, 815-341-5919

Thank you for supporting community-run Radio Harbor Country! For more info, visit radioharborcountry.org

Personal Details
Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email *
Your answer
Phone *
Your answer
Birthdate *
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Registration Details
How many riders are included in this registration? *
Your answer
Names of riders in addition to yourself included in this registration. *
If the riders in your group are not all confirmed at this time, please note that here and someone from WRHC will follow up with you. Names of all riders are required for waivers.
Your answer
Payment Method *
Someone from WRHC will follow up with you regarding payment if not completed at the time of registration.
Can WRHC include photos of you in future promotions? *
In registering for the WRHC 2019 Bike-N-Brunch:
- I agree to ride safely, signal my movements, be alert to my surroundings, stay to the right when riding slowly and pass on the left of other participants.
- I agree to obey the rules and directions of the ride’s organizers and volunteers. This includes wearing a helmet during the ride.
- I understand that bicycling involves risks and can result in loss of personal property, bodily injury or even death.
- I personally assume any and all of the risks associated with participation in this event, and I release, absolve, indemnify and hold harmless WRHC and all of their directors, officers, sponsors and volunteers from any manner of liability, claims for damages or causes of action.

- IF REGISTERING A MINOR(S), I affirm that I am the custodial parent or legal guardian of the minor. I consent to the above terms, including the waiver and release of claims, on behalf of the minor(s). I affirm I have the authority to grant such consent, and I agree to supervise the minor(s) and ensure that the above terms are followed by the minor(s).

By clicking the box below, you agree to the terms listed in the Waiver: *
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