Kelly's Ride
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Registration.
Kelly's Ride 2010 - Saturday, June 5
Destination: Ocean City, NJ Recreation Fields
65, 40 and 25 mile options.
Rider Information
First Name:
Middle Initial:
Last Name:
Address:
City:
State:
Zip Code:
Phone:
Date of Birth:
Email:
Emergency #:
Team Affiliation, if any:
 
Route Option:
Start Point #1
7 AM., Johnsons Family Corner Farm, Medford NJ at intersection of Church and Hartford Roads- Distance 65 miles, especially for the advanced rider who trains all year.
Start Point #2
8:30 AM., Francesco's Restaurant, Route 73 Cedar Brook, NJ - Distance 40 miles, challenging the casual rider who is training for the event.
Start Point #3:
10AM., George Hess Education Complex, 700 Babcock Road, Mays Landing, NJ EZ Cruise 25 miler, a great beginning to the summer cycling season.

T-Shirt Size*
 

How did you learn about Kelly's Ride?
 
Payment Information and Fee Schedule  
Registration through April 15 2010 $40.00
Registration April 16 - May 15, 2010$50.00
Registration May 16 - June 5, 2010 $60.00
Donations in support of riders can also be applied securely online at www.kellysride.com. All online donations made in support of an individual participant will be applied to the registered rider's online total. Online totals can be tracked by individual riders by clicking on the home page, "rider stats" button until June 1, 2010.
Registration Cost $40
Additional Donation$
Total Due
Method of Payment:
Name on Card:
Card Number:
Card Expiration Date:   / 
Credit card verification code (3 or 4 digit code on your card):
Waiver:
I agree to participate in Kelly's Ride at my own risk. I understand that bicycling involves certain dangers and I am prepared to assume responsibility for myself and all minors under my care. I acknowledge any and all risks which might be associated with this event.

I will abide by all traffic laws, rules and regulations and agree to waive all claims regarding injury or property damage that may arise against anyone involved with Kelly's Ride, including its officers, employees, sponsors, organizers, volunteers, and any other representatives and their heirs and successors and assignees. I also agree to wear a performance certified helmet. I warrant that I am in proper condition to participate in this event.

I understand that all of the above terms shall apply to any minors under my care as well.

Furthermore, I give my authority, permission and consent to treatment by any medical/emergency provider to treat me in the case of injury, illness, fatigue or any emergency situation where I am not able to give my verbal consent.

This waiver is absolute and is binding on me, my heirs, successors and/or assigns. When I submit this form I constitute my understanding and agreement to all of the above without reservation.
Checking this box indicates your acceptance of these terms:
Date:

Kelly's Ride is a fundraising event sponsored by Kelly's Kids Inc., a 501c3 non-profit organization