Rider's 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 Michael at 510-849-4663 x307 or email michael@borp.org before continuing with your registration.
Email* Enter Email Again* Phone*
Cell Phone Address Line 1* Address Line 2 City* State* Zip* Country Select a team:
- Please Select -
I just registered a team
ALCO P-POTS
AT&T Pioneers
Bonkers
BORP Bay Cruisers
BORP Power Soccer
BORP Not Bombs
Chinn Finn
Davis Bike Club
DFL's
Downey Cycle Vision
Fiftybaht
Pumphrey-Martos Team
Push Hard Wheelchair Team
Reinventing the Wheel
Sam's Team
Sonoma Cyclers
Special Need For Speed
Talia's Smilers
Team Alameda
Team In Training
Team La Vie Subite
Team La Mision
Team Yak
The Babes Plus....
The Kaias
To the Max
Totally Awesome Team Rhino
Touchstone Climbing
Veloraptors
Viva la Vida
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 .
Gender
Birthdate MM 01 02 03 04 05 06 07 08 09 10 11 12 / DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / YYYY 2010 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952
1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
Rider Information
Riders, tell us about your bike *
Which route do you plan to ride? * - please select - 10 Miles/Trail Ride 25 Miles 50 Miles 65 Miles (100K) 100 Miles 10 Miles/Trail Ride, 25 Miles, 50 Miles, 65 Miles (100K), 100 Miles
If you are riding a handcycle, trike or tandem, and have one, who is your out-rider or tandem captain?
Please have your out-rider or tandem captain fill out a volunteer registration form and include your name as their partner. If you need an out-rider or tandem captain, please email greg@borp.org .
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$5,000 : Deluxe Cycling Accessory Pack + 1 Extra Festival Ticket$7,500 : $100 REI Gift Certificate+Deluxe Cycling Accessory Pack$10,000 : Custom Bike+Deluxe Cycling Accessory Pack$150 : (for youth under 18 yrs only) Festival+T-Shirt+Swag Bag
Does your employer have a matching gift program?
Who is your employer?
Do you require a vegetarian meal?
Revolution 2010 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.
What style jersey do you wear? - please select - Women's Men's Club (Looser Fit L-XXL Only) Men's Racing (S-L Only) (Women's, Men's Club or Men's Racing)
What is your cycling jersey size? - please select - XS S M L XL XXL (Men's only) XXXL (Men's only) (XS, S, M, L, XL, XXL*, XXXL* - *Men's Only)
What is your T-Shirt size? * - please select - Women's XS Women's S Women's M Women's L Women's XL Men's XS Men's S Men's M Men's L Men's XL XXL (Men's only) (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 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.
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 October 16, 2010 (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 October 16, 2010, 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. 8923 -->Type that number here--> Bottom of Form 
