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					 Registration Form for 10-30-65 Mile                                                      Registration Form for Brett’s Tot Ride                                                                                 5th Annual




                                                                                                                                                                             U.S. POSTAGE


                                                                                                                                                                             PERMIT #178
                                                                                                                                                                             HICKORY, NC
                                                                                                                                                                              PRESORTED
                                                                                                                                                                              STANDARD

                                                                                                                                                                                PAID
Name:                                                                                     Name:
Address:
City/State/Zip:
                                                                                          Address:
                                                                                          City/State/Zip:
                                                                                                                                                                                                      Brett’s Ride
Phone #:                                                                                  Phone #:                                                                                                          for Rhabdo
E-mail address:                                                                           E-mail address:
Age on Oct. 5, 2008:                                                                      Age on Oct. 5, 2008:
Registration Fee                                                                          Registration Fee
   $25 by October 4th                  $30 day of the ride
                                                                                               $10.00 (Tot Ride)
   10 mile    30 mile                    65 mile
T-Shirt: Adult                 S M L XL XXL                                               T-Shirt:        2T          4T           6/8             10/12
     or Youth                   Medium Large                                                 Mail with check and completed information to:                                                                       Oct 5th, 2008
Socks (DeFeet):                S M L XL                                                                  Brett’s Ride for Rhabdo                                                                                 10-30-65 Mile
    Mail with check and completed information to:                                                              .O.
                                                                                                              P Box 5314
                Brett’s Ride for Rhabdo                                                                    Hickory, NC 28603                                                                                      Hickory, NC
         P Box 5314, Hickory, NC 28603
          .O.                                                                                                       Or
                           Or                                                                Turn in your completed form and payment to:
    Turn in your completed form and payment to:                                                           Rock N Road Bicycles
                 Rock N Road Bicycles                                                                   2435 North Center Street
    2435 North Center Street, Hickory, NC 28601                                                            Hickory, NC 28601
                    828-324-9350                                                                             828-324-9350
                           Or                                                                                       Or
                                                                                                   Register online at www.active.com
          Register online at www.active.com
                                                                                                                    Or
                                                                                                                                                                                                            Hosted by the Hickory
                           Or
              Hickory Foundation YMCA                                                                  Hickory Foundation YMCA                                                                               Foundation YMCA
            Sunday, October 5th at 7:30am                                                            Sunday, October 5th at 7:30am

        HELMETS REQUIRED                                                                         HELMETS REQUIRED                                                                                         Accept the Challenge!
WAIVER OF LIABILITY: I fully assume and understand the risks of
participating in an open course ride including death or injury due to vehicles,
                                                                                          WAIVER OF LIABILITY: I fully assume and understand the risks of
                                                                                          participating in an open course ride including death or injury due to
                                                                                                                                                                                                         All proceeds benefit research and
falls, collisions with other participants or spectators, actions by hostile humans
or animals, uneven pavement, obstructions, adverse weather, sudden illness,
                                                                                          vehicles, falls, collisions with other participants or spectators, actions by                                 awareness for all types of childhood
                                                                                          hostile humans or animals, uneven pavement, obstructions, adverse
and all other risks. I attest that I am physically fit to participate. I authorize ride
officials to provide medical attention at my expense should I appear in need.
                                                                                          weather, sudden illness, and all other risks. I attest that I am physically fit                              cancer, including rhabdomyosarcoma
                                                                                          to participate. I authorize ride officials to provide medical attention at
For injuries I sustain, including death, I agree to save and hold harmless the
                                                                                          my expense should I appear in need. For injuries I sustain, including
                                                                                                                                                                                                        (rhabdo), a childhood cancer of the
YMCA of Catawba Valley, Hickory Velo Club, City of Hickory, local
government, law enforcement personnel, volunteers, event staff, suppliers,                death, I agree to save and hold harmless the YMCA of Catawba Valley,
                                                                                          Hickory Velo Club, City of Hickory, local government, law enforcement
                                                                                                                                                                                                            muscle that affects less than
contractors and anyone else connected with the organization of this event,
                                                                                                                                                                                                              300 children every year.



                                                                                                                                                                            Brett’s Ride for Rhabdo
from any claim or lawsuit that my be brought at any time by me, my family,                personnel, volunteers, event staff, suppliers, contractors and anyone else
                                                                                          connected with the organization of this event, from any claim or lawsuit




                                                                                                                                                                              Hickory, NC 28603
estate, heirs or assigns, arising from my participation in this event or the
instruction I received. (Helmets Required)                                                that my be brought at any time by me, my family, estate, heirs or assigns,                                   Proceeds of this event will be donated



                                                                                                                                                                                 P.O. Box 5314
WAIVER OF PUBLICITY: I agree that images taken of me during this event                    arising from my participation in this event or the instruction I received.
may be used in any legal manner without payment to me. I have read and
understand the terms of this document. I make this agreement and pay my
                                                                                          (Helmets Required)                                                                                          to the Wake Forest University School of
                                                                                          WAIVER OF PUBLICITY: I agree that images taken of me during this
entry fee in exchange for the privilege of participating under the conditions of          event may be used in any legal manner without payment to me. I have                                         Medicine, specifically to the Section on
the event.                                                                                read and understand the terms of this document. I make this agreement
                                                                                          and pay my entry fee in exchange for the privilege of participating under
                                                                                                                                                                                                        Pediatric Hematology and Oncology.
Signature:
                                                                                          the conditions of the event.
Signature of parent/guardian
if under 18:
                                                                                          Signature of parent/guardian:
                                                                                                                                                                                                         Ride For Pediatric
                                                                                                                                                                                                         Cancer Research!
          5th Annual                                                                                                                 2008 Sponsors
                                          Brett’s Tot Ride
Brett’s Ride                                     Entry fee: $10.00
                                           Includes Short-Sleeve T-shirt
                                                                                                                                                           (So far...)
                                                                                                                                                     Platinum
                                                                                                                                        Dale Jarrett Foundation, Inc.
     Location of Start and Finish
                                                   Floating Time:                                                                        Draka Elevator Products
      Hickory Foundation YMCA
                                                10:00am - 12:00pm                                                                       Rock N Road Bicycles, LLC
         701 First Street NW
             Hickory, NC                    Location of Start and Finish                                                                                     Gold
                                         YMCA Half-Mile Track located behind            10-30-65 Mile                            Alex Lee, Inc. The George Foundation, Inc.
          For Directions                                                                                                                   The David Baker Family
     www.ymcacatawbavalley.org             the Hickory Foundation YMCA                 Ride for Pediatric                                    DeFeet International
          828-324-2858
                                          Take your child on a ride around the
                                                                                       Cancer Research                                 Gastroenterology Associates, PA
                                                                                                                                          The Mike Johnson Family
    For Ride & Route Information           track in a stroller, wagon, tricycle or   Sunday, October 5th, 2008                      Piedmont Pathology Associates, Inc.
      www.hickoryveloclub.com                  bicycle with training wheels             Start Time - 9:00am                                    Vesco Toyotalift
                                                   (helmets required).                                                                                       Silver
              To Register
      By mail - use form on back
                                         Stop at the treat stands for refreshments
                                                                                               Ride
                                                                                      Brett’sFee                                  Elaine and Tim Bolick • Catawba Valley Medical Center/
                                                                                                                                 Frye Regional Medical Center • Cheerwine-RC, of Hickory
                                                                                                                                     CommunityOne Bank, NA • Corning Cable Systems
       Online - www.active.com
                                                and at the safety station to             Entry                                     Marty and Joab Cotton • Drs. Darab & Richardson, PA
                                                                                                                                          Davidson, Holland, Whitesell & Co., PLLC
 In person - at Rock N Road Bicycles        check helmet fit, tire pressure and         of $25.00 includes:                        Greater Hickory Classic at Rock Barn Presented by Kia
                                                                                                                                    Joe Greene Design • David C Hamilton, Jr., DDS, MS
     or Sunday, Oct. 5th at YMCA                       for safety tips.                                                      Hickory Velo Club • Hix Studios • Ice Cream Engineers of America
              at 7:30am                                                                * T-Shirt                                            Kellex Corporation • Market on Main
                                                                                                                                      Pepsi-Cola Bottling Company of Hickory, NC, Inc.
                                                                                       * Pair of DeFeet socks                          Piedmont Endocrinology, PA • Ramsey Finishing
             Packet Pick-up                All those registered for the Tot Ride        (to first 1000 registrants)                    Reed Dermatology • Mr. and Mrs. Jeffrey Rocks
                                                                                                                                   Angela and Rob Simmons • Thomas-Bain Leather, Inc.
          Rock N Road Bicycles             will be eligible to win a kid’s bike.                                                          Valdese Weavers • Wal-Mart Foundation
                                           Kid’s bike includes a kid’s helmet.         * Brett’s Ride Decal
  Friday, October 3rd, from 1pm - 7pm                                                                                                                       Bronze
Saturday, October 4th, from 10am - 5pm                                                 * Opportunity to Win                     Ace Hardware • Alice Bishopric, MD • Allegra Print & Imaging • BB&T
                                                                                                                              The Biltmore Financial Group, Inc. • Brainworks Learning Center of Hickory
                   or                                                                    Door Prizes:                                     Mr. and Mrs. Robert Braswell • Campbell & Associates
                                                                                                                                      Carolina Orthopaedic Specialists • Carolina Swatching, Inc.
        Hickory Foundation YMCA                                                         - Weekly badges and golf packages      Catawba Pediatrics Associates, PA • Catawba Radiological Associates, Inc.
                                                                                                                                      Claremont Family Medicine, PA • CommScope, Inc., of NC
                                                                                        from the Greater Hickory Classic      David E. Looper & Company • The Diamonti Family • Cathi and Dan Dillon
     Sunday, October 5th, at 7:30am                                                     at Rock Barn for riders registered               First Security Insurance • Mr. and Mrs. Forest M. Gaines
                                                                                                                                  Mr. and Mrs. Tim Gaines • Graystone Ophthalmology Associates, PA
                                                                                        by September 1st, 2008.                        Groucho's Deli of Hickory • The Family of Jalen Gwaltney


    HELMETS                                                                             - A Bicycle from
                                                                                        Rock N Road Bicycles
                                                                                                                                          Hancock and Moore • Harlee Packaging Components
                                                                                                                                       Hickory Fireplace & Patio • Hickory High School Students
                                                                                                                                 Hickory Springs Manufacturing Co. • The Hickory Surgical Clinic, Inc.
                                                                                                                                      Michael M Hirsch, MD, PLLC • Hometown Sports of Hickory


    REQUIRED
                                                                                                                             Eagle and Lynn Howe • Betty and Mike Isenhour • Jackson Group Interactive
                                                                                                                                 S. Kimberly Jones, DDS • Kidz Who Care • Whitney and Charlie King
                                                                                                                              Lance Transportation • Leather Miracles, LLC • Madaris Transportation, LLC
                                                                                                                                             Dr. and Mrs. Ralph W. Maynard, III • Lisa Meares
                                                                                                                                 Merrill Lynch Private Client Group • Mt. Olive Lutheran Church Youth
                                                                                                                                             Peoples Bank • Providence House Furniture, Inc.
  If you would like to make a                                                                                                                Sally Brown,Hen & Chicken Papers/Sarah Swatzel
                                                                                                                                        Shane Greene Photography • Shurtape Technologies,LLC
tax-deductible donation, please                                                                                                            Sigmon, Clark, Mackie, Hutton, Hanvey & Ferrell, PA
                                                                                                                                            Revaughn and George Snow • SW Associates, Inc.
                                                                                                                                Taylor & Viola, Structural Engineers • Unifour Anesthesia Associates, PA
         send check to:                                                                                                                  United Beverages of NC, LLC • Von Drehle Corporation
                                                                                                                                                     Windy City Grill • Wykes Cleaners
     Brett’s Ride for Rhabdo                                                                                                 If you would like to make a tax-deductible donation,
          P.O. Box 5314                                                                                                                      please send check to:
       Hickory, NC 28603                                                                                                                    Brett’s Ride for Rhabdo
                                                                                                                                     P.O. Box 5314 • Hickory, NC 28603

				
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