Third Annual…

Tour de Tifton Charity Bike Ride

Rides available for beginner to experienced riders; 11, 25, 45, 62, & 100 miles.

Saturday, March 31, 2012

Proceeds to benefit Tiftarea YMCA programs and scholarships for underprivileged youth

TIME: Registration opens 7:00 am; Mass start at 8:00 am

LOCATION: Ride begins and ends at the Tiftarea YMCA at 1823 Westover Rd, Tifton, GA, about 1 mile west of I-75, Exit 63-B. Routes pass through Tift and surrounding counties.

ENTRY FEE: Pre-registration (before March 15) is $25 per person or $40 for a family. Children (under 16 y) – must be accompanied by a parent or legal guardian rider. Late registration (after March 15) and registration on the day of the event is $35 per person and $50 for families. On-line registration available at www.tiftareaymca.org.

AMENITIES: All pre-registered participants will receive a T-shirt; event day registrants will be eligible for t-shirts while supplies last. All participants will get free snacks/drinks at SAG stops along the course and a post-ride meal. Participants completing either of the century courses will receive a special gift.

THE COURSES: The routes take you through the gently rolling countryside of the Tiftarea. There will be a beginner’s 11 mile course, intermediate level 25 and 45 mile loops, and 62 and 100 mile century routes for advanced riders (you must finish within 7 hours).

Further Information Contact: Tiftarea YMCA at 229 391-9622 or www.tiftareaymca.org

Helmets are required to ride!

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Send completed application and registration fee to:
Tiftarea YMCA, 1823 Westover Rd, Tifton, GA 31793. One entry per form. Please print neatly.

Name: ____________________________________________ Email: _________________________ Phone: _________________

Address: __________________________________________ Age: _______ Birthday: _______________ Gender: M___ F___

City: _______________________________ State: _____ Zip: _______________ T-Shirt Size (circle one): YM YL AS AM AL AXL AXXL

Emergency Contact: (name)_____________________________(phone number)_______________________________________

Event (check one): o 10-15 mile ride o 25 mile ride o 40 mile ride o 62 mile ride o 100 mile ride

Fee(checks payable to Tiftarea YMCA): Before March 15: o $25 for individual; o $40 for family

After March 15: o $35 for individual; o $50 for family

If registering as a family, and application must be filled out for each member and submitted together. Family includes biological or legally adopted children and their parents and grandparents. Other members registering in your family:___________________________________________________________________________________________

Release: In consideration and acceptance of this entry, I, the undersigned intending to be legally bound, hereby waive any and all claims for myself, my heirs, and executors/administrators, against the Tiftarea YMCA and/or officials, hosts, organizers, or sponsors of the Tour de Tifton Century Bike Ride for injury, illness, or death which may directly or indirectly result from my participation. I further attest that I am in proper physical condition to participate in this event. I give my full permission for the event organizers to use of my name and photograph in any broadcast, telecast, website or any other visual, oral or written account of the event for any purpose and for free.

_________________________________________ ___________________ ___________________________________________________________

Signature Date Parent’s Signature (if entrant is under 18 years old)