18th Annual Parrot Head Club
Bike Ride for Our Environment Registration
Saturday, October 5, 2013, 9 AM starting and ending at the Mary Ann Brown Nature Preserve in St. Francisville, LA. You can choose either a 19- or 27-mile bicycle ride to raise money for the Nature Conservancy of LA and the Bluebonnet Swamp Nature Center.
Each participant will receive a collector's edition 14th Annual Parrot Head Bike Ride for Our Environment T-shirt and ride packet, rest stops with drinks/fruit, and lunch and drinks after the ride. Riders are required to provide and use their own helmets.
The cost is $20.00 to pre-register and $25.00 to register the day of the ride. Registration on ride day begins at 7:30 AM.
Directions to the Mary Ann Brown Nature Preserve: From Hwy. 61, turn NE onto Hwy. 965. Travel about 6 miles and the preserve is on the left (across from The Bluffs). From Hwy. 966, veer east onto Hwy. 965 and travel 1.2 miles.
Participant Information
Name(s): ______
Address: ______City, State, Zip: ______
Phone numbers: ______
I will participate in the: 19-Mile Ride ______27-Mile Ride ______
T-shirt size: Small ______Med ______Large ______XL ______XXL ______XXXL ______
*Registration must be received by Sept. 8, 2009 to ensure T-shirt size selection.
If pre-registering, Please make checks payable to: LOODPHC, and mail with registration form to:
Parrot Head Club Bike Ride c/o Charlotte Baronne
18135 Creek Hollow Road Baton Rouge, LA 70817
If you have any questions, please contact Charlotte at 225-751-0623 or Amy at 225-337-1031.
Participant Release Waiver
In signing this release, I (we) acknowledge that I (we) understand the intent thereof and I (we) hereby agree and will absolve and hold harmless the Loyal Order of DisOrder Parrot Head Club of Baton Rouge, corporate sponsors, cooperating organizations, and any other parties connected with this event in any way, singularly, or collectively from and against any blante and liability for any injury, misadventure, harm, loss, inconvenience, or damage hereby suffered or sustained as a result of participation in the Bike Ride for the Environment or any other activities associated herewith. I (we) also hereby consent to and permit emergency treatment in the event of injury or illness. I (we) further agree to follow all applicable traffic laws, conduct my activities in a safe and prudent manner and wear a helmet.
Signature (parent of legal guardian if under 18 years old)
"The Loyal Order of DisOrder Parrot Head Club of Baton Rouge is a non-profit organization whose purpose is to assist in local community and environmental concerns, and to provide a variety of social activities for people with similar tastes and interests. "