66 on 66 BIKE TOUR ENTRY FORM

RELEASE OF ALL CLAIMS

This release made on ________________, 1998, at Bethany, Oklahoma. In consideration of permission granted to me to participate in Bike tour activity described actions, causes of action, damages, claims, or demands which I may have against the Bethany Chamber of Commerce, and other above-described parties for all personal injuries, known or unknown, which I may incur by reason of participation in the Bike tour activity.

I have read the foregoing Release and understand its terms and execute it voluntarily with full knowledge of its significance. I have with full knowledge of this Release voluntarily agreed to participate in this Bike tour activity.

Dated ____________________, 1998 Signature ______________________________

Entry Fee: $15

Circle T-Shirt Size L XL XXL (First come first serve)

Registration Information
(Please Print)

NAME__________________________________________

ADDRESS _________________________________________________

CITY ______________________________________ STATE __________ ZIP _______________

PHONE ___________________________ AGE _______

Route You Plan to Take

____ Family Fun Ride Around Lake Overholser (12 mi.)	____ 25 Mile (Yukon)
____ 50 Mile (El Reno)	____ 66 Mile (Ft. Reno)

Mail form and entry fee to:

Bethany Chamber of Commerce
P.O. Box 144
6656 N.W. 39th St.
Bethany, OK 73008