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UrbanTrekkers Pedal for Promise Rider Registration May 1, 2010 Pedal for Promise is a 50-mile bike ride from Glassboro, NJ to Ocean City, NJ. Our goal is for each rider to raise a minimum of $200 to help fund UrbanTrekkers, an expeditionary learning program at UrbanPromise. For more information contact Jim at jcummings@urbanpromiseusa.org Number of Riders: 123456 $25 per rider Team Name: (if applicable) Rider 1 Rider Name: Address: City: State: Select State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Phone: Email: T-Shirt: 1 Medium Large X-Large XX-Large Return Transportation: 2 Yes (add $15) No Bike Rental: 3 Yes (add $25) No Liability Release: 4 Yes No Rider 2 Rider Name: Address: City: State: Select State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Phone: Email: T-Shirt: 1 Medium Large X-Large XX-Large Return Transportation: 2 Yes (add $15) No Bike Rental: 3 Yes (add $25) No Liability Release: 4 Yes No Rider 3 Rider Name: Address: City: State: Select State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Phone: Email: T-Shirt: 1 Medium Large X-Large XX-Large Return Transportation: 2 Yes (add $15) No Bike Rental: 3 Yes (add $25) No Liability Release: 4 Yes No Rider 4 Rider Name: Address: City: State: Select State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Phone: Email: T-Shirt: 1 Medium Large X-Large XX-Large Return Transportation: 2 Yes (add $15) No Bike Rental: 3 Yes (add $25) No Liability Release: 4 Yes No Rider 5 Rider Name: Address: City: State: Select State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Phone: Email: T-Shirt: 1 Medium Large X-Large XX-Large Return Transportation: 2 Yes (add $15) No Bike Rental: 3 Yes (add $25) No Liability Release: 4 Yes No Rider 6 Rider Name: Address: City: State: Select State Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Phone: Email: T-Shirt: 1 Medium Large X-Large XX-Large Return Transportation: 2 Yes (add $15) No Bike Rental: 3 Yes (add $25) No Liability Release: 4 Yes No Notes: 1 T-shirts will be provided to all riders who register by April 20, 2010. 2 Return transportation is available upon request ($15 fee). Our UrbanTrekker bus will leave Holy Trinity Church in Ocean City at 4pm and return to Rowan University parking lot. A truck will also follow to return your bike. Seats are limited. 3 Tuckahoe Bike Shop will rent bikes for this event for $25 per bike. Bikes will be delivered to the Rowan University parking lot the morning of the event and picked up in Ocean City at 4pm. 4 Medical/Liability Release, Waiver, Discharge and Covenant Not to Sue: I fully recognize the dangers that may result from participating in this activity. I also agree to save and hold harmless, indemnify, and release all parties involved in this event from liability, loss, cost, claim, or damage. All bikers must wear bike helmets. I have read and agree to this waiver.

Copyright © 2010 Urban Trekkers, PO Box 1479, Camden, NJ 08105