Veterans United Arizona

Event Signing up for*

Bike Build

ParticipantDonatorSponsor

Concert

ParticipantVenderDonatorSponsor

Donator

FundsServicesItems

Bike Build Participant Type

Poker Run Entry $35.00 each includes 1 $10.00 concert ticket (pre registration only) $15.00 at door.

1 Poker Run entry with ticket to concert

Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

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Postal / Zip CodeCountry

E-mail*

Phone Number*

Area CodePhone Number

Release of Libility:

I hereby agree to hold harmless Veterans United Arizona, Lake Havasu City and all entries associated with this event, any injury or claim of injury due to tripping, falling or any other type of injury while attending this event.

I hereby provide for my own insurance to cover any and all personal liability issues that may arise from my participation in this event.

I am the sole person responsible for the use of LOGOs and advertisement for my group unless otherwise indicated for National Approval for Service Organizations.

I am aware that I must Provide a Business License and Insurance to participate.

I have a restriction of no more than 4 people in my group on any specific day.

Acknowledgement of Liability release above.*

First NameLast Name

Date of Signing*

Date

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