Waiver:

In consideration of this entry, I, for myself, my heirs, executors, administrators and personal representatives, waive and release all rights and claims for damage I may have against the Heart of the Rockies Chamber of Commerce, The City of Salida, the US Forest Service, Bureau of Land Management, Participating Private Owners, and all other sponsors, their agents, representatives, employees, successors, and assigns arising from my participation in the 14th Annual Banana Belt Bicycle Festival. These events involve riding a bicycle on varying surfaces where the possibility exists of collision with a vehicle, another cyclist, or other moving or stationary objects. I recognize the inherent danger of this event, and I agree to faithfully adhere to the safety rules and to specific commands issued by law enforcement and other race personnel on the racecourse. I realize that the timely arrival of medical assistance may not be assured and I acknowledge that I am in good physical condition to participate safely in the race. I also realize that it is my responsibility to have personal medical insurance in effect to cover any medical expenses arising from my participation in the Banana Belt Mountain Bike Race, Trials, and related activities. I further agree to hold above sponsors harmless and indemnify them against all claims, damages, judgment, costs and attorneys’ fees should they be held liable for any damages I may sustain arising from the event.

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Participant's Signature

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Parent or Guardian (if under 18)

Registration Form:

Name: ___________________________________________________________________________

Address: ___________________________________________________________________________

_____________________________________ ______________________ _______________________

Phone Number: Home: ____________________________Work: _______________________________

Check The Following:
Banana Belt Mountain Bike Loop ____ Banana Split ____
Gender: Male ____Female ____ Age _______ Single Speed or Tandem Category_____
Registration Fee: $2 of your registration fee goes to Salida Parks, Open Space and Trails

Trials & Banana Belt Loop
Re-Registration ~ Before 5 pm on Friday, September 10th $27
Race Day Registration ~ 8-9:30 am at Riverside Park $35

T-Shirt is Med___ Lg____ XL___

Make checks payable to: HRCC
Mail Registration to:
406 W. Hwy 50
Salida, CO 81201
Fax to 719.539.7844
Phone in registration 877.772.5432 or 719.539.2068

Additional T-shirts for $12 each Med____ Lg___ XL___

Amount Enclosed (Include Extra T-Shirt Payment): _______________________________________

CC#__________________________________________________ Expiration Date________________

Signature___________________________________________________________________________