Registration - Samaritan Ministries

First Name*

Middle Initial

Last Name*

Date of Birth*

Must be 18 or older.

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Home phone

Emergency Contact Name*

First Last

Emergency Contact Phone*

Waiver

I am aware that participation in Tour de Llama is dangerous and I am voluntarily participating in this activity with the knowledge of the dangers involved and hereby agree to accept any and all risks of injury or death suffered by me as a result of my participation in this activity. I release Samaritan Ministries, Ken’s Bike Shop and al sponsors from any claim for injury that may result. I understand that an Ansi/Snell approved helmet must be worn by me at all times on the course. I understand that this is not a closed course and I must abide by the rules of the road. I hereby give permission to Samaritan Ministries to use my name and any photography taken of me during the event in any promotional materials or publications. I certify that I have read this waiver and release and understand its significance. No refunds.

Click to agree

Agree

Note—all riders must check in morning of ride and sign a copy of this waiver.

Ride*

21 miles
38 miles
61 miles

Cost of ride
Price: $30

Register Additional Riders?

Additional Registrants

First Name	Middle Initial	Last Name	Birth Date	E-mail	Emergency Contact Name	Emergency Contact Phone Number

Please provide the information above for each additional rider.

Bronze Level Sponsorship: $250 - Enter quantity

Silver Level Sponsorship: $500 - Enter quantity

Gold Level Sponsorship: $1,000 - Enter quantity

Sponsorship Information

Deadline for sponsors is June 5.

Sponsorship Name

I would like to make an additional gift to Samaritan

Amount

I would like this donation to be

note: recurring gifts add up to make a big difference!

Tribute type:

Title

First Name

Middle Initial

Last Name

Bronze Sponsorship Discount

Silver Sponsorship Discount

Silver Sponsorship Discount 1 extra rider

Gold Sponsorship Discount

Gold Sponsorship Discount 1 extra rider

Gold Sponsorship Discount 2 extra riders

Gold Sponsorship Discount 3 or more extra riders

Total Cost of Registrations

Price: $0.00

Total Cost of Bronze Sponsorship(s) *includes 1 rider

Price: $0.00

Total Cost of Silver Sponsorship(s) *includes 2 riders

Price: $0.00

Total Cost of Gold Sponsorship(s) *includes 4 riders

Price: $0.00

Total Cost of Additional Gift

Price: $0.00

Total Cost

Price: $0.00

Online Registration

Tour de Llama 2020 Registration

Waiver