2012 Mum Festival Bike Tour
Registration: Registration cut off is September 26, 2012. Late registration will cost $5 more per rider and be available the same
day of the event. The ride will be limited to 600 riders. No refunds after September 24th.
Check In: 9/30/2012 Registration starts at 7:00 AM at Tippecanoe High School, 615 E. Kesslar-Cowesville Rd. in
Tipp City, Ohio. Course maps will be provided and riders must be finished with their rides by 4:00 PM. Rides
will begin at 7:30 AM.
Support: Maps will be provided the day of the ride. Rider support will be provided on every course. It is recommended that
you carry a cell phone during the ride in case of emergency. Phone numbers will also be provided.
Routes will be clearly marked before, during, and after each turn.
Rest Stops: Hydration, snacks, and fresh fruit will be provided at every rest stop.
Routes: The 100 mile endurance ride (7:30 AM start). 60 Mile Enthusiast ride (7:45 AM start), 30 mile sport ride (8:00 AM)
and the 15 mile family ride (8:15 AM start)
2012 Mum Festival Bike Tour
(NO REFUNDS AFTER SEPTEMBER 24TH)
□ $15 Early registration (per rider)
□ $20 Late registration (per rider after 9/24/2012)
□ $10 T-Shirt □ Small □ Medium □ Large □ X Large □ XX Large □ XXXLarge ($5 more)
Release - By signing this release for myself or on behalf of the named entrant if the entrant is under eighteen (18) years of age, and in consideration of the acceptance of this application for entry of this event, I do for myself, my heirs, my assigns and personal representatives (or, if applicable, for my child or ward and his or her heirs, assigns and personal representatives), hereby (1) waive, release and forever discharge any and all claims or rights that presently exist or may hereafter accrue against Shifting Gears Cycling and The Tipp City Mum Festival, its officers and members, respectively, and any other parties connected with this event in any way whatsoever, singularly and collectively, arising from or by reason of any bodily or personal injuries or property damage, misadventure, harm, loss or inconvenience, that may be sustained as a result of participation in this event or any activities associated therewith, and (2) consent to permit emergency treatment in the event of an injury or illness. I further understand that failure to wear a CPSC approved bicycle helmet is a risk and that I may be exposing myself to a head injury or death in case of an accident. I attest that I am physically fit and have completed training for this event. I also understand that all riders under the age of 14 must be accompanied by an adult.
An additional liability release will need to be signed at registration. Registering now will reserve a spot for the Mum Festival ride however, you can not participate unless a waiver is filled out on sight and in person.
Printed Name ______________________________________________________
Signature of parent or Guardian (under 18) ______________________________
Emergency contact and phone number _________________________________
Date _______________________Email ____________________________________
□ Return registration by mailing to:
(make checks payable to)
Tipp City Mum Festival
PO Box 1
Tipp City, Ohio 45371