2014 STAGECOACH CENTURY APPLICATION Saturday, Jan 18, 2014 | Start Window: 7:00 - 9:00 A.M. | Ocotillo, California, USA | www.ShadowTour.com First Name: * _______________________________ Last Name * _______________________________________ Address: * ___________________________________________________________________________________ City: *_______________________________________________ State: * ___________ Zip: * ________________ Best Tele: * ________________________________ DOB: (MM/DD/YYYY) * _______________ Sex: (M/F) * ___ Email: * _________________________________ Please reprint email: *_________________________________ Emergency Contact: * ______________________________________ Tele: * _____________________________ Entry Category: CIRCLE FEE Includes: Lunch/Medal/Pin Price Deadlines: Full Course w/TT (up to 100 mi) Best Deal Jul 31 $70 Super Saver Aug 31 $80 Early Bird Sep 30 $85 Fall Value Prices Prices Oct 31 Nov 30 $90 $95 Standard Prices Dec 31 $100 Last Chance Walk-up Reg’s Jan 17 Jan 18 $105 $110 (Visit website for Solo & Team Time Trial Rules, Forms, and Details) Full Course (up to 100 mi) $70 $80 $85 Short Course (26 – 50 mi) $55 $65 $70 Optional Items (including tax): Post Ride Pasta Meal: $12 $12 $12 T-shirt Hanes Cool Dri Tec: $22 $22 $22 Jersey Voler Club Fit: $75 $75 $75 Entry Category Fee…….………………………………$__________ Promocode: _______________ (applies only to Entry Fee) $(_________) SUBTOTAL………………………………..…. $__________ Optional Post-ride Pasta Meal(s) ___ x $12/$15…... $__________ $90 $75 $95 $80 $100 $85 $105 $90 $110 $95 $12 $22 $75 $12 $22 $75 $12 $22 $75 $12 $25 $80 $15 $25 $85 Office Use Only DBI _____ Bib # ______ Ck # ______ R/O# ______ Pd $ ______ Ck $ ______ Optional T-shirt(s) ___ x $22/$25, Size:____........... $__________ Checks payable to: Shadow Tour, LLC . Mail to: 13143 Kellam Ct, #41 San Diego, CA 92130 Optional Jersey(s) ___ x $75/$80/$85, Size:____.... $__________ GRAND TOTAL......................................... $__________ SELECT LOCATION * for included lunch: Shelter Valley (halfway): ___ or Ocotillo (S/F): ___ (blank = Ocotillo) Previous Shadow Tour Events: 1-23 ____ Stagecoach: 1- 11 ____ Affiliation (club/team): ___________________________ Optional T-shirt: Mz: Wz: Optional Jersey: Mz: (Voler Club Fit) Wz: Instructions/Notes: (Hanes Tec T’s!) MXS ___ WXS n/a MXS ___ WXS ___ MS ___ WS ___ MS ___ WS ___ MM ___ WM ___ MM ___ WM ___ ML ___ WL ___ ML ___ WL ___ MXL ___ WXL ___ MXL ___ WXL ___ M2XL ___ W2XL ___ M2XL ___ W2XL ___ M3XL ___ W3XL ___ M3XL ___ W3XL ___ 1. Please clearly print all mandatory (*) info. Incomplete/illegible data slows down acceptance. Event held rain or shine. 2. LUNCH MEAL IS INCLUDED with all ride distances. POST-RIDE MEAL IS OPTIONAL: $12 in advance, $15 Sat. 3. Refunds/Rollovers/Transfers are permitted per Shadow Tour Policies. See website for more details. 4. Registration is for 2014 STAGECOACH CENTURY ONLY. Carefully review prices and associated postmark deadlines. 5. Riders will receive instructions and weather conditions by email from [email protected] and [email protected]. 6. Limit one rider per Registration Form. Tandems, teams, and clubs register as individual riders. 7. Deadline to mail registration is Jan 8, ‘14. Afterward, riders may register online, or in person, at packet pick-up Fri & Sat. 8. Jerseys: Jerseys ordered by Nov 15, ‘13 will be at packet pick-up. After Nov 15, ’13 Jerseys will be mailed in Mar ‘14. 9. T-Shirts: Riders ordering T-shirts will receive them at packet pick-up. Refunds will be issued if sizes/quantities run out. 10. Unclaimed Gear Bags/Rider Packets will be mailed upon receipt of $8 to cover shipping expenses. Liability Waiver: In consideration of acceptance of this entry, I hereby, for myself, my heirs, my executors and administrators, waive any and all rights and claims for damages I may have against all participating coordinating groups and municipalities, and any individuals associated with this event, their representatives, successors and assigns, and will hold them harmless for any and all injuries and/or damages suffered in connection with this event. I have been warned that bicycling is a dangerous sport and that I must be in good health to participate in this event. I must obey all traffic laws and wear a helmet while participating in this event. In accepting this waiver, I acknowledge I have read and fully understand my own liability and do accept these limitations and restrictions. I will comply with all Shadow Tour, LLC Policies and Rider Instructions, including reservation of photography rights and the Refund/Rollover/Transfer policies. If applicable, I accept that this waiver continues with a Rollover/Transfer, and I will insure Transferees complete required waiver forms. I will carefully read and abide by all Final Rider Instructions. I fully acknowledge that cycling requires me to be alert at all times. I will ride as if my life depends upon my own actions and decisions. Shadow Tour, LLC is not responsible for undelivered emails. Children under 18 years of age must have parent or guardian sign the event waiver on their behalf. I/We have read and agree to the Shadow Tour, LLC Liability Waiver and Policies: X ______________________________________________ /Signature/ Date: ____________