REGISTRATION-

Mail to Embry's Bike Shop, 602 N. Main Street,

Leitchfield, KY  42754

Name: ______________________________________________________

Address: _____________________________________________________

City: ________________________________________________________

State: _______________________  Zip: ____________________________

Tour (circle one)   15 Miles           30 Miles          45 Miles         62 Miles         

Age: _____________________________

I hereby assume any and all risks which might be associated with the event.  I further waive, release, discharge and covenant not to sue any partner/representative associated with the R.A.C.K. Tour, for any and all injuries or damages of any kind whatsoever suffered by myself or anyone else taking part in the event.

_____________________________________________   __________________________

Participant's Signature                                                        Date

_____________________________________________    __________________________

Parent's Signature (if under 18)                                        Date