5Thannual LOOP!Presented by the Lansing Area Chamber of Commerce

5thAnnual LOOP!Presented by the Lansing Area Chamber of Commerce

In partnership with the Village of Lansing and Lan-Oak Park District

6 p.m. – 11 p.m.July 21st, 2017- Park Plaza

First Name: Last Name:

Email address:

Address: City: State: Zip:

Phone:______Cell:______T-Shirt Size (circle) Adult S M L XL XXL

If registering group of 10 or more, use the back of this sheet. Youth S M L XL

Check One: Age Under 18_____Age 18 or over____ Gender: F_____ M_____

Admission: includes T-shirt, backpack, food

****EARLY BIRD SPECIAL $15.00- FROM APRIL 1ST-JUNE 1ST****

June 2nd - June 23: $20/ June 24– July 14: $30/ After July14 and at the door: $40

(Shirts and backpacks not guaranteed with registration after July 14)

Group rate: $18 each for groups of 10 or more

Make checks payable to: Lansing Area Chamber of Commerce

Registration and payment available online at

Waiver: Participating in The LOOP! on July 21st, 2017

• I agree that my level of fitness is appropriate to participate in the event;
• I agree that my bicycle is in safe operating condition, and I will follow the

IL Bicycling requirement of white light in front and rear red reflector;

• I agree to not wear headphones or use a mobile phone while biking in the event;
• I agree to ride safely, signal my movements, be alert to my surroundings, stay to the right when riding slowly and pass on the left of other participants;
• I agree to obey the rules and directions of the Lansing Area Chamber of Commerce organizers and volunteers, and its agents, including wearing a helmet;
• I understand that bicycling involves risks and can result in loss of personal property, bodily injury or even death;
• I personally assume any and all of the risks associated with participation in this event;
• I release, absolve, indemnify and hold harmless the Lansing Area Chamber of Commerce, Cook County, Cook County Forest Preserve District, the Lan-Oak Park District, their agents and/or employees, and the Village of Lansing, IL and all of its employees, directors, sponsors and volunteers from any manner ofliability, claims for damages or causes of action.

IF REGISTERING A MINOR(S), I affirm that I am the custodial parent or legal guardian of the minor. I consent to the above terms, including the waiver and release of claims on behalf of the minor(s). I affirm I have the authority to grant such consent, and I agree to supervise the minor(s) and ensure that the above terms are followed by the minor(s).
* / I affirm that I am at least 18 years of age, and have read and understand the terms of participation in The LOOP! in the document above.
Name:______Date______
Signature______

Lansing Area Chamber of Commerce 18155 Roy St. Suite 3, Lansing, IL 60438 708-474-4170

Additional Group Participants

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