STREET ADDRESS:

CITY :

PROVINCE/STATE

COUNTRY

I am interested in riding the Tour du Canada in: ________

Please indicate above which year you plan to ride the Tour du Canada. If you do not know or have no plans to ride this trip please indicate N/A.

Please subscribe / do not subscribee me to the Tour du Canada Network

Please indicate if you wish to subscribe to the Tour du Canada Network at the above e-mail address.

Information on the Tour du Canada Network can be found at: http://www.TourduCanada.com/network.htm

WAIVER AND RELEASE OF LIABILITY AGREEMENT. PLEASE READ AND SIGN THIS AGREEMENT:

In consideration of the acceptance of my application for membership in Tour du Canada I, for myself, my heirs, executors, administrators, successors and assigns hereby release, waive and forever discharge Cycle Canada, The Veloforce Corporation and/or Tour du Canada, and all supporting bodies, associations, advertisers and sponsors and all of their respective agents, officials, volunteers, servants, contractors, representatives, successors and assigns of and from all claims, demands, damages, costs, expenses, actions and causes of actions, whether in law or equity, in respect of my membership.

I ACKNOWLEDGE HAVING READ THIS WAIVER AGREEMENT, FULLY UNDERSTOOD ITS TERMS AND SIGN FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT

SIGNATURE_________________________________________________DATE___________________

FOR PARTICIPANTS OF MINORITY AGE(under age 18 at time of registration) This is to certify that I, as parent/guaradian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the releasees, and, for myself, my heirs, assigns and next of kin, I release and agree to indemnify the releasees from any and all liabilities to my minor child's involvement, membership or participation in these programs as provided above.

PARENT GUARADIAN SIGNATURE______________________________________PRINT NAME & DATE BELOW