RAGBRAI Transport and Support Application
This waiver and payment form must be submitted by March 31, 2018. Please fill out one form for each person going on RAGBRAI. (including minors)
Email address *
Rider Name *
Your answer
Rider Street Address *
Your answer
Rider Town *
Your answer
Rider State *
Your answer
Rider Zip Code *
Your answer
Rider Cell Phone *
Your answer
Type of bike are you bringing on RAGBRAI? *
Required
T-Shirt Size *
How many RAGBRAIs have you been on? *
Your answer
How did you pay your 2018 Bike Burlington membership dues? *
Required
How many days will you be traveling with Bike Burlington? *
Emergency Contact Name *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Phone Number 2
Your answer
Convenant 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 convenants 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 negligence of Bike Burlington, Inc. it's officers or agents.
*
Required
How are you paying for your transport/support package? *
Parent or Guardian Signature(if rider is under 18)
Are you traveling/paying with another person (s)? Please list them below.
Your answer
A copy of your responses will be emailed to the address you provided.
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