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