ENTRY FORM
(Please print and make copies as needed)

Entry fee: $25 if postmarked by March 7th. After March 7th and on day of ride $30.  Make checks payable to and mail to:

Kiwanis Club of Pike County, PO Box 1204, Zebulon, GA 30295. You can pay by credit card at www.active.com.

See our web site at www.kiwanispike.org or call Don Collins at 770 567-3033, or e-mail nutty1@hughes.net.

First Name__________________________ Last Name_________________________________

Address__________________________________City________________State___Zip________

Phone___________________ E-mail_______________________________________________

Age____ Male___ Female___ Please check T-shirt size: S__ M__ L__ XL__ XXL__

Check distance:  __8 mile easy; __18 mile easy; __33 mile moderate; __ 66 mile & 100 mile strenuous

Waiver / release Form: In consideration of this entry, I waive any and all claims for myself and my heirs against the Kiwanis International Foundation, the Kiwanis Club of Pike County and their respective officials, sponsors, and volunteers, Pike County, Pike County Sheriff's Dept., State Patrol of Georgia, as well as the Cities of Concord, Molena, Meansville, Zebulon and Williamson and their respective officials, of the 2008 Tour de Pike Century for illness or injury which may result in injury or death directly or indirectly for my participation in the 2008 Tour de Pike Century. I understand that bicycling or in-line skating can be a hazard that could result in injury or even death. I am in proper physical condition to participate in this event.

Signature________________________________________Date_________________

Parent or Guardian sign below if entrant is under 18 years of age on March 15, 2008.

Signature___________________________________Date_____________Relationship_______