REGISTER ONLINE or download application form at WWW.HBL.ORG
Sunday, September 30th, 2012
Kapiolani Park 6:15 a.m.
Ride the 31st annual Honolulu Century Ride, Hawaii's Merchandise
largest cycling event! Purchase oﬃcial Honolulu Century Ride and Hawaii
Bicycle 20, 25, 50, 75 or 100 miles from Waikiki past Diamond Bicycling League Gear at www.hbl.org/shop.
Head to the Koolau mountains:
Sandy Beach, Kailua, Kahaluu, and up to Kaaawa. Return and Start Order
park your bike at Kapiolani Park and enjoy ono food, live Determined by riding style and ability for an enjoyable, safe
entertainment and meet new cycling friends from around the ride. Group A starts in front, Group D in the back.
world. Group A
The ride supports the Hawaii Bicycling League. Our mission is Ride monthly 300 miles/19mph avg (500km/30km/hr),
to get more people to ride bicycles for health, recreation and Experienced with group riding.
transportation by making Hawaii’s streets safer Through Group B
advocacy, education, and events. Ride monthly 120miles/13mph avg (200km/20km/hr).
Experienced in long rides.
REGISTRATION Group C
Online, Mail, Fax until 9/28 5pm HST Ride less than 20 miles per week. Ride slowly and enjoy the
Hawaii Bicycling League scenery. Longest recommended distance is 50 miles.
3442 Waialae Ave, Suite 1, Honolulu HI 96816. Group D
Fax: 808-735-7989 www.hbl.org For parents with children under 5. Longest recommended
distance is 20 miles. All children under 15 must be accom-
panied by an adult.
Packet Pickup and Ride Day 9/29 – 9/30
Registration in person only.
Course Closure Times
For safety cyclists must be at the ﬁnish by 5 pm. To ride 75
miles you MUST pass Kailua by 11:00am. To ride 100 miles you
MUST pass Kamehameha / Kahekili (Hygienic Store) by
10:30am. If you arrive after these times you will be asked to
turn back to the ﬁnish line for your safety. Aid station closing
times posted in Ride Guide. Kapiolani Park and the course
close at 5pm.
Bicycle Helmets & Headphones
Bicycle helmets are mandatory, must be properly fastened at
all times. Headphones, ear buds not allowed.
Packet Pick-Up (Rider #) SATURDAY, 9/29/12
Waikiki Elementary School – 3710 Leahi Ave. Check www.hbl.org for updates.
(Corner of Leahi and Monsarrat) 8:30am – 3pm
Packets are not available at the HBL oﬃce.
Phone 808-735-5756 | Fax 808-735-7989 | 3442 Waialae Ave., Suite 1, Honolulu, HI 96816 | www.hbl.org | email@example.com
2012 Honolulu Century Ride Official Registration Form
LAST NAME FIRST NAME AGE ☐ MALE ☐ FEMALE
ADDRESS CITY / STATE ZIP / COUNTRY
HBL MEMBER NUMBER HOW DID YOU HEAR ABOUT THE RIDE?
CIRCLE RIDE ORDER
☐ Bike Shop ☐ Jamba Juice ☐ TV ☐ Web ☐
Word of Mouth A B C D
EMERGENCY CONTACT EMERGENCY PHONE #
Team Iron Okole “Iron Butt” Competition
RELEASE, WAIVER OF LIABILITY, Visit www.hbl.org/ironokole for more information and to register a team.
ASSUMPTION OF RISK, and Packet
INDEMNITY AGREEMENT Early Regular Late Pickup &
Ends 5/31 6/1-8/31 9/1-9/28 Ride Day
In exchange for being permitted to participate 9/29-9/30
in Hawaii Bicycling League (HBL) sponsored
bicycling Activities, I understand, agree and Hawaii / US Residents
represent (for myself, assigns, heirs, personal
HBL Member $60 $70 $80 $100 $
representatives, and next of kin) that:
Risks and dangers. The Activities will be on Non-Member $75 $85 $95 $130
public roads open to vehicles, where many
hazards can be expected. I can be seriously Keiki
$35 $35 $35 $35
injured, permanently disabled, paralyzed, or <15 accompanied by adult $
die. I will read, listen and follow safety International (Residence Outside of Hawaii / US)
instructions and warnings on the course.
Japan Residents Register at www.honolulucenturyride.jp until 8/31/12, thereafter use www.hbl.org.
Personal responsibility and Acceptance of HBL Member $115 $125 $135 $145
Risks. I am qualified, in good health and $
proper physical condition to participate. I am Non-Member $135 $145 $155 $165
personally responsible and will use my own $
judgment for my safety. If conditions are Keiki
unsafe I will immediately stop participating. I $35 $35 $35 $35
<15 accompanied by adult $
accept and assume the risk of injury caused
by me, the negligence of others, the course
and conditions, including risks and Circle size (unisex): XS, S, M, L, XL, XXL
social/economic losses not known or readily Limited quantities and sizes for registrations after 9/14/12.
foreseeable at this time.
Circle size (unisex): XS, S, M, L, XL, XXL
Photography I provide Hawaii Bicycling
2012 Century Ride Jersey
HBL Member $75, Non-Member $90 $
League permission for free use of name,
voice, picture, video in news and advertising. Circle size (unisex): XS, S, M, L, XL, XXL
2012 HBL Jersey
Photos will be posted online for web orders. HBL Member $75, Non-Member $90 $
Release of others and indemnification. I
Ono plate lunch at Kapiolani Park 10am-4pm
release, discharge, and agree not to sue HBL Community organization fundraisers. Pay at the park. All lunches are served with rice and salad.
employees/directors/members/volunteers, What are you interested in?
participants, owners/lessors/lessees/ ☐
Beef Stew ☐
BBQ Chicken ☐
Kalua Pork ☐
Garlic Shrimp ☐
Veggie Burger ☐
licensees of land where the Activities take
place (Releasees). If a claim involves me, I
☐ $25 Individual 1yr ☐ $500 Lifetime
will indemnify, save and hold harmless each ☐ $31 Family 1yr (names):
of the Releasees from litigation expenses,
attorney fees, loss, liability, damage, or costs. Donation to HBL for Safer Streets and Bicycle Education $
Giving up substantial rights. I have read Total $
and understand that I have given up
substantial rights by signing this agreement. I
am to be bound by it as a complete and
unconditional release of all liability to the Payment
greatest extent allowed by law. ☐ Cash ☐ Check (Payable to HBL)
For Minors (Under 18). I am the ☐ Charge (MasterCard, Visa, AMEX, Discover) 3-Digit Code on Back _________
parent/legal guardian of the minor. An adult
will accompany minors under 15 years old.
Card # __________________________________________ Expiration Date (MM / YY) __________
Participant/Parent/Legal Guardian Signature _____________________________________________ ________________________
Cardholder Signature Date
Print Name of Participant Age
Entries are non-transferable and non-refundable.
Phone 808-735-5756 | Fax 808-735-7989 | 3442 Waialae Ave., Suite 1, Honolulu HI 96816 | www.hbl.org | firstname.lastname@example.org