Tour de Palm Springs - Ride Fees for 2013 Event. Please print one form per rider. Riders must show
registration wrist bands in order to enter SAG stops for food, water and bike support

First and Last Name / Age
Street Address
City / State / Zip
Daytime Phone / Cell Phone
Email Address
Emergency Contact / Contact's Phone

Registration includes one t-shirt per entry. Please circle desired size: S M L XL XXL XXXL

Mile Ride / Entry Fee Over 12 / Entry Fee Under 12 / Late Fee
After January 31, 2013 / Participant
1 Mile / $5 / Free with adult / No Late Fee / N/A
5 Mile / $25 / $10 / No Late Fee / N/A
10 Mile / $25 / $10 / No Late Fee / N/A
15 Mile / $25 / $10 / No Late Fee / N/A
25 Mile / $40 / $40 / +$10 / N/A
55 Mile / $55 / $55 / +$10 / N/A
100 Mile / $60 / $60 / +$10 / N/A
100 Mile Tandem
$42.50 per person / $85 (sponsored) / $85 / +$10 / Cyclist:
55 Mile Tandem
$42.50 per person / $85 (sponsored) / $85 / +$10 / Cyclist:
25 Mile Tandem
$27.50 per person / $55 / $55 / +$10 / N/A
5/10/15 Mile Tandem
$22.50 per person / $45 / $45 / N/A
1 Mile Tandem
$5 per person / $10 / $10 / N/A
Extra T-Shirt / $10 Plus Tax / S M L XL XXL XXXL / $
Jersey / $70 Plus Tax / XS S M L XL XXL XXXL / $

I have read and agreed to the Waiver and Release .I am 18 years or older OR I am under 18 years of age and my parent/guardian has signed off on my behalf.

Signature: ______Date: ______

Make check payable to: CVSPIN - Tour de Palm Springs. Remember to print ONE FORM PER PERSON.

Mail form(s) and check to: CVSPIN - Tour de Palm Springs, 74854 Velie Way Suite#9 Palm Desert, CA 92260 Phone (760) 674-4700 - Fax (760) 674-4730 - Tax ID#33-0836672

Tour de Palm Springs – Waiver and Release

In consideration of your acceptance of this entry, I hereby, for myself, my heirs, my executors and administrators, waive any and all rights and claims for damages I may have against CVSPIN, Inc., its employees, agents, representative, assigns and anyone else working with them, and all participating groups, and any individuals associated with this event, their representatives, successors and assigns and will hold them harmless for any and all injuries and/or damages suffered by me in connection with this event. In addition, I grant permission by the Tour de Pam Springs to use my image and any photos, motion pictures, records or any form of record for this event for any legitimate purpose. I have been warned that bicycling is a dangerous sport and that I must be in good health to participate in this event. I must obey all traffic laws and wear a helmet while participating in this event. In filing out this form, I acknowledge I have read and fully understand my own liability and do accept the restrictions.

Children under 18 years of age must have parent or guardian sign on their behalf.