HBL Century ride app final

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					               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 | bicycle@hbl.org
2012 Honolulu Century Ride                                                                                     Official Registration Form
 LAST NAME                                                                           FIRST NAME                                       AGE               ☐ MALE ☐ FEMALE

 ADDRESS                                                                             CITY / STATE                                     ZIP / COUNTRY

 PHONE                                                                               EMAIL

 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 &
                                                       Registration                                                                                               Total
                                                                                           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
                                                       Dry-fit T-Shirt
 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 ☐	
 Shave Ice
 licensees of land where the Activities take
 place (Releasees). If a claim involves me, I
                                                                                          ☐ $25 Individual 1yr ☐ $500 Lifetime
                                                       HBL Membership
 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 | bicycle@hbl.org

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