In consideration for the opportunity to participate in the Air Force Blue Streak Bicycle Time Trials (TTs) at Wright Patterson Air Force Base, Ohio the undersigned expressly agrees as follows:

a.    To save, hold harmless, indemnify, and defend the United States and its agents, employees, and instrumentalities from and against any and all liability claims, costs and suits of whatever kind, including but not limited to personal injuries and property damage, occurring and in connection with, or in any way incident to or arising out of my activity or conduct while upon or about Wright-Patterson Air Force Base, Ohio.

b.    To assume responsibility for and indemnify the United States, and its employees, agents, and instrumentalities, for any and all loss or damage of whatever kind and however caused to any and all United States Government property, if such loss or damage is a result of my negligence or misconduct.

c.    I hereby consent to any medical treatment necessary for me in the event of my injury or illness and agree to pay any and all costs associated with such medical treatment. I am aware that this event requires physical endurance and I am aware of the danger normally associated with bicycle riding. I will wear appropriate protective equipment, to include a bicycle helmet during the event. To save, hold harmless, indemnify, and defend the Dayton Cycling Club (DCC) and its agents, volunteers, members and instrumentalities from and against any and all liability claims, costs and suits of whatever kind, including but not limited to personal injuries and property damage, occurring and in connection with, or in any way incident to or arising out of my activity or conduct while upon or about Wright-Patterson Air Force Base, Ohio

Name

First    Last      Date

Birthdate:               Gender (Male/Female):

Date of Time Trial you wish to participate in:

Class:  Single HPV Tandem Triplet

Tandem or Triplet Partner Name(s):

AF Affliation:  AF Member Military AF Contractor None

DCC Member #:        Complete DCC Mileage Form

E-Mail Address:      I will assist the following 2008 TimeTrials:  Jun Jul Aug

I have ridden the Blue Streak TTs before (Yes/No):

Estimated average speed over 10 mile distance (MPH):

Signed Form must be submitted at Time Trail      Signature:______________________________________________________