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{{ 'FIRST-NAME' | translate}}

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No emails or URLs allowed

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No emails or URLs allowed

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{{ 'BIRTH-DATE' | translate}}

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{{ 'ADDRESS' | translate }}

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ASSUMPTION OF ALL RISKS BY THE ENTRANT: With the full knowledge and appreciation that bicycle riding is a hazardous activity and that this event takes place in a rural setting with roads of varying design and construction not under the control of the Pueblo of Acoma, in consideration of your accepting this entry you knowingly and intentionally agree to the following statement:  I unconditionally waive and release any rights of claim I may have now or in the future against the Tour de Acoma organizers, their agents, towns, counties tribes and state in which event is run, their representatives, successors, assignees for any and all personal injuries and/or property damage suffered by me in said event or arising from my participation in said event.  I attest that I am physically fit to ride in this event and am 18 years old or older.

 

_______________________________________

ENTRANT

 

******************************************************************

WHERE ENTRANT IS UNDER 18 YEARS OF AGE.

 

ASSUMPTION OF ALL RISKS BY THE PARENT, LEGAL GUARDIAN OR CUSTODIAN OF ENTRANT:

With the full knowledge and appreciation that bicycle riding is a hazardous activity and that this event takes place in a rural setting with roads of varying design and construction not under the control of the Tour de Acoma organizers, in consideration of your permitting ___________________  (“Entrant”) to enter and participate in this event,  you knowingly and intentionally agree to the following statement:    I unconditionally waive and release any rights of claim Entrant or I may have now or in the future against the Tour de Acoma organizers, their agents, towns, counties tribes and state in which event is run, their representatives, successors, assignees for any and all personal injuries and/or property damage suffered by Entrant in said event or arising from Entrant’s participation in said event.  I attest that I am the parent, guardian, or legal custodian of the Entrant, and that the Entrant is physically fit to ride in this event.  I hold the Tour de Acoma organizers, and their agents, harmless from any and all liabilities, which may occur as a result of Entrant’s participation in  Tour de Acoma.

 

_______________________________________

PARENT, LEGAL GUARDIAN OR

CUSTODIAN OF ENTRANT NAMED ABOVE

 

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SKU# {{product.sku}}
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{{ 'SUBTOTAL' | translate}} : {{cart.subtotal | currency:"$":currency.decimal}}
{{customFee.description}} : {{customFee.price | currency:"$":currency.decimal}}
{{ 'PROCESSING_FEE' | translate }} : {{cart.fee | currency:"$":currency.decimal}}
{{ 'SALES_FEE' | translate}} : {{cart.totalSales | currency:"$":currency.decimal}}
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{{customFee.description}} : {{customFee.price | currency:"$": currency.decimal}}
{{ 'PROCESSING_FEE' | translate }} : {{cart.lotteryFee | currency:"$":currency.decimal}}
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{{ 'COUNTRY' | translate }}

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{{ 'STREET' | translate }}

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{{ 'REGION' | translate }}

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{{ 'CARD-NUMBER' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-CREDIT-CARD-NUMBER' | translate }}

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{{ 'SECURITY-CODE' | translate }} (CSC/CVC/CVV)

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