2012 Baxter Fun Days
Lynnette and Chad Richey Chicaqua Valley Trail
“Cancer Schmancer” Bicycle Ride
Friday, June 29, 2012
**Helmet Required**
Schedule of Events
3:00-6:00 p.m Registration at Cadillac Jacks, Baxter
3:00-6:00 p.m. Open ride to Mingo begins; water station/break area at Ira Community Center
4:00-8:00 p.m. Mingo Parks and Rec Club: music, brats, and walking tacos
8:30 p.m. Raffle winners announced at Cadillac Jacks
You do not have to be present to win!
10:00 p.m. “Shag Wagon” from Mingo to Baxter makes its last trip! / Fees:
$10—Registration Fee; you can pre-register by mail or on the day of the ride.
Registration:
Mail the completed form with fee to:
Dana Berry-Fun Days Bicycle Ride
6741 Center St. Ira, IA 50127
Any questions, contact Dana @ 641-521-6744
or email: / Information:
We are riding from Cadillac Jacks to Ozzies Bar in Mingo with a water station located in Ira; parents please use your own discretion, if children attend they must be accompanied by an adult at all times.
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Welcome to the 2012 Baxter Fun Days “Cancer Schmancer” Bicycle Ride!
Name (Last, First): ______
Birth date: Age on 7/9/11: Sex: M F
Address: ______
City, State, Zip Code: ______
Phone______
Email: ______
Release: I know that participating in this race is a potentially hazardous activity. I should not enter and participate in this race unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the race. I assume all risks associated with running and volunteering to work in club races including, but not limited to falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the road and traffic on the race route, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Baxter Fun Days Committee and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in the race and/or activities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I grant permission to all the foregoing to use any photographs, motion pictures, recordings, and any other record of this event for any legitimate purpose.
Signature: Date: ______
Parent Signature, if under 18 years: ______
Registration is $10.00
Make checks payable to: Dana Berry/Mercy Cancer Center, ***you do not have to ride to donate***
Mail form and check to:
Dana Berry
6741 Center St.
Ira, IA 50127