Saturday, November 3rd, 2007      9:00 a.m.


Registration begins at 8:00 a.m. at Ansonville Elementary School

Please use only one registration per entrant; you are free to make additional copies of this form as needed.

I will be cycling in:

   30-mile ride         50-mile ride         70-mile ride

Name ___________________________________________________________

Age (on day of event) _______________________________________________

   Male         Female

Mailing Address: __________________________________________________

Phone: __________________________________________________________

E-mail: __________________________________________________________

Emergency Contact:

Name____________________________________________________________

Phone: __________________________________________________________

T-Shirt Size (Circle):      M      L      XL		 Following the ride, come join us at the Ansonville Homecoming Celebration. Crafts, entertainment, barbecue and a parade highlight the daylong celebration.

All routes are marked and patrolled by staff in cars and SAG Wagon. Staff will be equipped with cell phones. Rest stops will be available for riders.

Event will be held rain or shine. There will be no refunds of registration fee.

Riders must wear helmets and follow all North Carolina traffic laws.

Please make $25 checks ($20 if registering prior to Oct. 19) payable to the Anson County Chamber of Commerce and mail to: Discover Anson Bike Ride, P.O. Box 305, Wadesboro, N.C., 28170.

Required Release (Must have appropriate signature):
I waive any and all claims against the Anson County Chamber of Commerce and the Anson County Tourism Development Authority, the Town of Ansonville, and Anson County and any other person or group assisting with this event, for illness or injury that may result directly or indirectly from my participation in the event. I am in proper physical condition to participate, and I am aware that participation in this event could, in some cirumstances, result in physical injury.

Participant's signature:__________________________________________________________________________________________

Guardian's signature (if participant under age 18):____________________________________________________________