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 Grayson County Tourism, for any and all injuries or damages of any kind whatsoever suffered by myself or anyone else taking part in the event held at Tammy's Playschool.

_____________________________________________   __________________________

Participant's Signature                                                        Date

_____________________________________________    __________________________

Parent's Signature (if under 18)                                        Date