September 21 – 23, 2007
Chattanooga, TN
Print this registration form, fill it out and mail it with the appropriate funds to:
Southern Tandem Rally
Eric Osgood
4211 N. Park Dr.
Tucker, GA 30084
Captain Name:Stoker Name:
Address: / Phone Number:
City, State Zip: / Email:
Emergency Contact Name:
Emergency Phone Number: / Tandem Make, Model, Color:
List all additional team members who will be attending the rally:
#3 Name:
#4 Name:
Cost: (includes Saturday breakfast, lunch, dinner, and Sunday breakfast and parking at the host hotel-- please note price does not include hotel as host hotel is full and other lodging arrangements must be made on your own).
Tandem team (captain and stoker)...... $230…………………………….. 230.00
Extra person/children over 12 (on 9/1/07)...... $120 per person …………………
Children ages 5-12 (on 9/1/07)...... $ 90 per child ……….………….
Children ages 0-4 (on 9/1/07)...... …………...... ………….……… FREE
Total enclosed: (please make checks payable to STR 2007) $
1. The host hotel is full, but there may be cancellations. If you are interested in being placed on the Host Hotel Wait List, please indicate below. If a room becomes available, we will contact you via e-mail. The additional cost for two nights at the Chattanoogan Hotel will be $270.
Yes, I want to be added to the Host Hotel Wait List.
Room Type (circle one – KING, DBL) (circle one – Smoking/Non-Smoking).
2. We have secured a block of rooms at the downtown Hampton Inn, only 1 mile from the host hotel. If you want to stay at the Hampton Inn, call 423-265-0077 and ask for the STR 2007 rate of $79/night (specify 2 DBL or 1K – S or NS). This rate is available Sept. 19 – 24 (the actual Rally is Sept. 21 – 23) but must be reserved before the Rally registration deadline of August 23. Please indicate below if you plan to reserve a room through the Hampton Inn.
Yes, I plan to use a room from the Hampton Inn room block (I realize I must contact them directly to make my reservation).
Contact rally organizers in advance for any special requests ().
The Fine Print - Waiver: In consideration of your allowing me to participate in the Southern Tandem Rally, I, intending to be legally bound, release and discharge any and all claims for damages, death, personal injury or property damage, which I may have, or which may hereafter accrue to me, as a result in my participation in this event. This waiver/release is intended to discharge in advance the Southern Tandem Rally, and its organizers from and against any and all liability arising out of or connected in any way with my participation in the Southern Tandem Rally, even though that liability may arise out of negligence or carelessness on the part of the Southern Tandem Rally, or its organizers.
I further understand that serious accidents occasionally do occur on bicycle rides and that participants occasionally sustain mortal or serious personal injuries, and/or property damage, as a consequence. Knowing the risks, nevertheless, I hereby agree to assume those risks and to release and hold harmless the Southern Tandem Rally and its organizers, who (through negligence or carelessness) might otherwise be liable to me for damages or injuries. It is further understood and agreed that this waiver, release and assumption of risk is binding on my estate, my heirs, and assigns. I agree to abide by all applicable laws and regulations. I will wear a Snell or ANSI approved helmet. I accept responsibility for the condition of my equipment. I agree that the above representations are contractually binding. I will accept and assume responsibility for my actions.
The deadline to register is August 23, 2007. I understand partial refunds are available until August 23, 2007 and there are NO refunds after August 23, 2007. I also understand there is a $20 refund charge.
Captain signature :______Stoker signature:______
Signature of parent or adult for children under 18: ______