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Phoenix Breakfast Lions Club
Ride For Sight bicycle ride registration form
(Please print legibly)
Rider 1: Last: _________________________ First: _______________________
Address: ___________________________________________
City ________________________________ State ____ Zip __________--_______
Email: ________________________________________________
Rider 2: Last: _________________________ First: _______________________
Address: ___________________________________________
City ________________________________ State ____ Zip __________--_______
Email: ________________________________________________
Rider #1 Medallion or t-shirt XL L M S (circle one)
Rider #2 Medallion or t-shirt XL L M S (circle one)
Day phone: ____________________ Evening phone: ____________________
Mail your entry to: Phoenix Breakfast Lions Club
12335 N. 58th Avenue Glendale, AZ 85304
I hereby release and hold harmless the Arizona Department of Transportation,
Lions International, all participating Lions clubs, Phoenix Breakfast Lions Club, as
well as its officers, event leaders, organizers and all event sponsors and participants
or any and all claims, causes of action or liabilities arising out of my participation in
this event. I further acknowledge that there is inherent risk of bodily harm and/or
damage in participating in any bicycle event, and I agree to assume the risks of such
participation.
__________ _______________________________
Date Signature
________ ________________________________
Date Signature of parent if rider is under 18
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