Rider Registration

Account Summary

Team Choice

No team, I will be riding on my own.

Donation Information

While participation is free, a $50 donation is suggested. Riders who donate $50 or more at registration will receive a shirt. Riders who donate/raise $500 or more will also receive a custom Cycle4Chiari jersey.

No donation $50 $75 $100 $150 $200 $250 Other
Donations of $50 or more.
Charge will appear on your statement as Conquer Chiari.

Fundraising Page

Searchable? Yes No

As a participant in Cycle4Chiari, you will have a fundraising page that you can use to ask family and friends to support your participation. If you make your fundraising page searchable, donors will be able to find it by searching for your name or email.

Waiver and Release

In consideration of the acceptance of my application for entry in Cycle4Chiari, I, the undersigned, for myself, my heirs, executors, administrators, next-of-kin, personal representatives and assigns, hereby forever waive, discharge and release in advance the promoters, sponsors, volunteers, the promoting clubs, the event officials, advertisers, the towns, cities, and counties through which I may choose to cycle as a result of my participation in Cycle4Chiari, and any other municipalities involved, and their respective agents, boards, commissions, employees and representatives, without limitation, as well as Conquer Chiari and its affiliates, volunteers, officers, directors, employees, members or the like (the foregoing being collectively referred to as “Releasees”) from any and all claims for damages, death, personal injury, loss of property or property damage, and any and all liability arising out of or connected in any way with my participation in the above-mentioned bicycle event, even though that liability may arise out of negligence or carelessness on the part of Releasees, that I may have, or that may subsequently accrue to me, or to my heirs, executors, administrators, next-of-kin, personal representatives or assigns, as a result of my participation in Cycle4Chiari.

I acknowledge that the intensity of my activities and the route used in connection with Cycle4Chiari is at my sole discretion. My participation is voluntary and done at my own risk. I voluntarily assume all risks of loss, damage, including property damage, or injury that may be sustained while participating in, or associated with, the above-mentioned event. I attest that the route chosen by me will be carefully examined by me prior to my participation and my participation will automatically constitute acceptance of the conditions of the route as being reasonable and safe for purposes of my intended use. I attest that I am familiar with, and agree to obey and abide by, federal, state and local laws, rules and regulations applicable to my participation in Cycle4Chiari. I attest that I am physically fit and sufficiently trained for this kind of event and my participation is not against medical advice. I acknowledge that no representations have been made as to the availability of medical care or assistance during my participation in Cycle4Chiari.

I further understand that serious accidents occasionally occur during bicycling, and that participants in bicycling or cycling events occasionally sustain mortal or serious personal injuries or property damage as a consequence of such participation, including but not limited to effects of falls, dehydration, contact with or action by other participants or spectators, weather (including high heat, cold, and humidity), traffic and conditions of the course or route, and all other risks associated with such an activity. Knowing these risks, I nevertheless agree to assume those risks, to release and hold harmless all Releasees who might be liable to me (or my heirs, executors, administrators, next-of-kin, personal representatives or assigns), whether as a result of Releasees’ negligence or carelessness or otherwise, and to refrain from bringing legal action for any injuries or loss associated with my participation in [name of event]. I further agree to indemnify and hold harmless Releasees from any loss, liability, damage or cost they might incur as a result of my participation in the above-mentioned event.

I attest that the bicycle and equipment I will use in Cycle4Chiari are in good mechanical condition and suitable for use in the event. I UNDERSTAND THAT WEARING A HELMET CAN PREVENT SERIOUS INJURY. I agree to accept and abide by the rules and regulations of the event as established and provided to me by Conquer Chiari.

I acknowledge that all fees, charges, bills and costs that may be incurred as a result of my participation in Cycle4Chiari, including but not limited to data usage fees, cellular charges, and electronic or mobile device charges, are my responsibility and shall not be in any way attributed to Conquer Chiari or any of the above-mentioned persons or entities.

In further consideration of the acceptance of my application for entry in Cycle4Chiari I grant full permission to Conquer Chiari and agents authorized by the promoters, to use photographs, videotapes and any other record of Conquer Chiari including my name, likeness and voice for any legitimate purpose.

I have read and understand everything written above and I voluntarily sign this waiver and release. I understand that the foregoing waiver and release is intended to be as broad and as inclusive as is permitted by applicable law, and that if any portion of it is held invalid, it is agreed that the balance shall continue in full legal force and effect. Helmets are strongly recommended for all riders and are mandatory for riders under 18 years of age.

By checking below, I acknowledge that I have read and agree to the above waiver and release:

Please check One of the following boxes

Acknowledgement of Participant:

Acknowledgment of Participant’s Parent/Guardian if Under 18 Years: