John Foss and the Gold Country Unicyclists Present the Eighth Annual
California Mountain Unicycle Weekend
We need your address information to keep in touch with you, to let you know about other events that may be scheduled!
NOTE: _________ Check here if you don’t have E-mail and need regular mail
City: __________________________________________ State: __________ Zip:
Phone: __________________________________ Email:
Birth Date: _____________________ Unicycling Society of America member? Yes_________ No _________
Name of guardian for participants under 18 yrs. of age: _______________________________________________
( ) Saturday at Rockville; trails of all types ( ) Saturday afternoon Games ( ) Saturday dinner and videos
( ) Sunday Downieville long from the top (shuttle) OR ( ) Sunday Downieville shorter ride from the bottom
In consideration of John Foss, Diana and Roger Miller, the Gold Country Unicyclists, Strategies to Empower People, the counties of Sacramento, Placer, Solano and Sierra counties, the state of California, and all other agents or representatives in any way connected with the California Mountain Unicycle Weekend on October 17–19, 2003 and allowing me to participate in the said event, I hereby waive, release and discharge forever said persons, organizations, corporations, and states from all claims, demands, rights, and causes of action of whatsoever kind and nature arising directly from any and all known, unknown, foreseen or unforeseen, bodily and personal injury, damage to property, and consequences thereof resulting from my participation in said California Mountain Unicycle Weekend. I assume all risks of injury or mishap resulting from my participation and covenant, not to sue the aforementioned parties for said injuries and/or damage. I am fully aware that I will be unicycling on unpaved roads and trails, and could potentially fall and sustain injuries or death. I participate with the full awareness that I am doing all of this at my own risk. I also permit you to provide, furnish or engage emergency medical treatment to me or my said son or daughter. I give permission for the use of my name and/or picture in any broadcast, telecast or other account of this event.
Signature Date Signature of Parent or Guardian
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