FREEZE YOUR FANNY
2008 Entry Form

February 2, 2008 - Ride Information
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Enter all information on this form, PRINT for an
EASY entry form to FREEZE YOUR FANNY in 2008

  • Entry Fee for the RUN is $10.00
  • Entry Fee for the RIDE is $20.00 (Children Under 16 is $10.00)
  • Family is $60.00 (maximum of 5)
  • Entry for both RUN and RIDE is $25.00 (Children Under 16 is $15.00)
  • AFTER JANUARY 25TH ADD $5.00 PER ENTRY

No Refunds.

Complete the form with a check
made payable to East Texas Lightnin' and mail to:
East Texas Lightnin'
600 W. Garfield Dr.
Longview, TX 75602

LAST NAME:
FIRST NAME MI:
ADDRESS:
CITY:
STATE: ZIP:
HOME PHONE:
WORK PHONE:
AGE: SEX:
T-SHIRT SIZE: S M L XL XXL (XXL Available for $1.50 extra)
T-shirts will be awarded to the first 100 RUN entrants AND the first 300 RIDE entrants.  
DISTANCE YOU
PLAN TO RUN
 5K 10K
Individual RUNNER
 $10.00
DISTANCE YOU
PLAN TO RIDE:
60 MI. 46 MI. 31 MI. 10 MI .
Individual RIDER
 $20.00
Individual RUNNER & RIDER
 $25.00
Total

Waiver and Release of All Claims

NOTICE: This entry blank release form is a contract with legal consequences. Read carefully before signing.
In consideration of the acceptance of my registration entry, I, the undersigned, assume full and complete responsibility for any injury or accident which may occur during my participation in the "Freeze Your Fanny." I hereby release Paula Martin Jones Charities, including all sponsors, the Longview Bicycle Club and their directors, officers, representatives, agents, and employees from any and all claims, demands, rights, or causes of action, present or future, whether known, anticipated, or unanticipated resulting from or arising out of, or incident to, in whole or in part, my participation in the "Freeze Your Fanny" bicycle tour and related activities whether or not caused by the negligence of any of the parties released hereby. I understand that I must ride in a safe manner. I have been required to use a hard shell helmet during my participation in the "Freeze Your Fanny." I understand that no one is authorized to make statements or representations either verbally or in writing which in any way contradict this Waver and Release of Claims.

HELMETS REQUIRED FOR THE RIDE
Children under 16 years of age must be accompanied by parent or guardian on the ride.
PRINT NAME:
SIGNATURE:
DATE:
CONSENT AND RELEASE OF PARENT OR GUARDIAN FOR PARTICIPANTS UNDER 18 YEARS OF AGE.

Signature of Parent or Guardian:
DATE:
YOU CAN ENTER THE INFORMATION ON THIS FORM AND PRINT IT OUT. BE SURE TO SIGN THE FORM WHERE NECESSARY AND SEND IT TO THE ABOVE ADDRESS WITH YOUR ENTRY FEE. AFTER PRINTING THE FORM YOU CAN THEN. . .
. . .RETURN TO FREEZE YOUR FANNY INFORMATION PAGE