RIDER REGISTRATION

Saturday September 26th, 2009

Trentadue Winery, Sonoma County CA

Rider Registration: Rider Registration is $35 before August 1st, and is $50 until registration closes (September 18th) or until the ride is full, whichever comes first.  Space is limited.

For your information, this is a multi-step process.  You will need to fill out this page, and then complete your Registration by paying with PayPal.  If you do not complete both steps, your registration has not been completed.

To register as a rider, please fill out this form.  *required fields
Rider's Name*
First Name
 Middle Name
 Last Name
IMPORTANT: If you are riding a tandem and you are the captain, please register as a VOLUNTEER. Then have the stoker register as the fundraising rider. If you have any questions, please call Mike at 510-849-4663 x313 or email mike@borp.org before continuing with your registration.
If you are joining a team, please select your team below.
Email*
Enter Email Again*
Day Phone*
   ext:
Don't forget your area code
Evening Phone
   ext:
Don't forget your area code
Cell Phone
So we can contact you during The Revolution. Please include area code.
Address Line 1*
Address Line 2
City*
State*
     Outside USA: 
Zip*
Country
Select a team:
IMPORTANT: If you want to start a team, and your team has not been created, you must go back and create your team before you register. To create a team, click HERE.  It might take 24 hours to add your team name, so continue with registration for now and enter your desired team name here:
Team Password:
(if required)
Gender
Male   Female
Birthdate
 /   / 


Rider Information
Riders, tell us about your bike *
I'll ride my own standard bike
I'll ride my own handcycle
I will borrow a BORP handcycle
I'll ride my own trike
I will borrow a BORP trike
I'll ride my own tandem
I will borrow a BORP tandem
Which route do you plan to ride? *
 
(10 Miles/Trail Ride, 25 Miles, 50 Miles, 65 Miles (100K), 100 Miles
If you are riding a handcycle, trike or tandem, who is your out-rider or tandem captain?
Please have your out-rider or tandem captain fill out their own registration form and include your name as their partner. If you need an out-rider or tandem captain to ride with, please contact BORP and let us know.
What is your fundraising goal? *
(The more money you raise, the more prizes you earn!)		 $350 (required minimum): Festival+T-Shirt+Swag Bag
$750: Event Jersey+T-Shirt+Swag Bag
$2,500: 1 Extra Festival Ticket+Event Jersey+Festival+T-Shirt
       +Swag Bag
$5,000: Deluxe Cycling Accessory Pack + 1 Extra Festival Ticket
       +Event Jersey+Festival+T-Shirt+Swag Bag
$7,500: $100 REI Gift Certificate+Deluxe Cycling Accessory Pack
      +1 Extra Festival Ticket+Event Jersey+Festival+T-Shirt+Swag Bag
$10,000: Custom Bike+Deluxe Cycling Accessory Pack
     +1 Extra Festival Ticket+Event Jersey+Festival+T-Shirt+Swag Bag
Does your employer have a matching gift program?
Yes
No

If yes, please contact your employer for an matching funds application and forward it to BORP.
Who is your employer?
For matching funds purposes only.
Do you require a vegetarian meal?
  Yes I require a vegetarian meal
  No I do not require a vegetarian meal
Revolution 2009 Cycling Jersey: Riders who meet fundraising incentives may earn a free cycling jersey*. If you plan to earn a prized jersey, please tell us your jersey size.

*Please choose appropriate fundraising level above.
What style jersey do you wear?
 
 (Women's, Men's Club, or Men's Racing)
What is your cycling jersey size?
 
(XS, S, M, L, XL, XXL*, XXXL* - *Men's Only)
What is your T-Shirt size? *
 
(Women's S, M, L, XL Men's S, M, L, XL, XXL)
Emergency Contact Info
Who should we contact in case of an emergency? *
How is this person related to you? *

(Mother, Father, friend, co-woker)
Emergency Contact Phone Number *

(Please include the area code)
Any other comments for the BORP Revolution Staff? 
      

Top of Form Type the number below into the box below (spam prevention):
   8923 -->Type that number here--> Bottom of Form
Would you like to be on the BORP mailing list?


RELEASE OF LIABILITY - READ BEFORE SIGNING

In consideration of being allowed to participate in any way in the Bay Area Outreach and Recreation Program (BORP), its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:   

1.    The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2.    I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3.    I willingly agree to comply with the stated and customary terms and conditions for participation.  If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately: and,

4.    I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Bay Area Outreach & Recreation Program (BORP), their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used for the activity ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property associated with my presence or participation, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.


FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as a parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

Type your initials here if you are in agreement with the liability waiver:
Your initials here (rqd)

FUNDRAISING MINIMUM & AUTHORIZATION TO CHARGE CREDIT CARD - READ BEFORE SIGNING

I understand that The Revolution is the most important fundraising event for BORP, and that I must raise a minimum amount for BORP in order to participate.

The following minimums include my non-refundable registration fee:

For Adult riders over the age of 18, the minimum amount to be raised is $350.

For Youth riders ages 8 - 18, the minimum amount to be raised is $150.

If by September 26, 2009 (the day of The Revolution) I have not raised the minimum amount, I authorize Bay Area Outreach & Recreation Program (BORP), to charge me for the difference between what I have raised and the minimum amount required to participate.  If I have not raised the minimum by September 26, 2009, I will bring with me to the Revolution a credit card, check, or cash in order to cover the difference and make a payment to reach the fundraising minimum.

Type your initials here if you are in agreement with the fundraising minimum:
Your initials here (rqd)

When you click below, you will be connected to our PayPal account for payment.  You do not need a PayPal account in order to process your payment if you click "Continue" on the bottom left-hand side of the page in the "Donate" have a PayPal account?" section.

 Note: We reserve the right to refuse service to anyone for any reason.