Houstonian Hammerheads Cycling Team

Ernest Johnson, Hammerhead top fundraiser, with fellow teammate Dr. Donald Baxter after Dr. Don received the Extra Mile Award.

Houstonian Hammerheads Registration Form

 

Name:
Houstonian Club Member#:
Houstonian Lite Member#:
Non-Member:
   
Home Address:
City:
State:
Zip:
Work#:
Home#:
Other#:
Email Address:
   

Clothing Options:
1. One jersey and one short
2. Two jerseys
3. Two shorts

(Additional jerseys or shorts can be purchased at $75 each)

Jersey Size (Unisex): XS S M L XL XXL 3XL None
Short Size (Gender Specific): S M L X L XXL None
If ordering shorts: Regular Bib
 
   
MS 150 Bike Tour Veteran: (number of year(s))
Current miles per hour speed
(in good conditions):
less than 15 15-17 17-19 19-21 22+
   
Emergency Contact Name:
Emergency Contact Number:
   

Assumption for Risk and Release:

I assume full responsibility for any personal injury, loss or damage which may occur to me in, on, or about the premises of The Club called The Houstonian and owned and operated by Houstonian Campus, Ltd. (a Texas limited partnership) (collectively “The Club”), including but without limitations to the events that may take place away from such premises and is sponsored by and/or supervised by The Club, its owners, operators, management, employees, volunteers, and agents, and their respective heirs, successors, and assigns, from any and all liability, rights of action, losses, claims, demands, costs and expenses for damages and/or personal injury, whether the same be known, anticipated or unanticipated that may occur to me, arising out of, regarding  or related to The Club’s activities, operations, management, equipment or facilities.  I have read this release, understand its terms and hereby excuse it voluntarily and with full knowledge and understanding of its legal significance.

Further, I understand that neither The Club nor its owners, operators, management, employees, volunteers or agents are permitted to transport me should I be injured, and I understand that The Club reserves the right to call emergency rescue services.  I consent to the rendering of emergency medical and/or hospital services, by and accredited hospital’s appointed physicians in the event that such need arises in the opinion of the duly licensed physician.

I have read the above statements and agree to all terms and policies associated with this program.
 

 

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