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Association of California Trailriders--ACT 2010 SIGN UP FORM

Name:

Address:

City:

State:

Zip:

Phone:

E-mail:

Riding Partner:

T-shirt Size:

MEMBERSHIP SIGN UP or

Already a 2010 ACT Member

$600 Premier Membership

$115 Monthly Membership

Month(s)

$25 Starter Membership

RIDE SIGN UP  Riding I-day only is not an option on 2-day destination rides
Trip Expenses:  The rides are free but a few rides have other personal costs each rider must pay for, i.e. meals, parking, gear truck, etc.    Lodging arrangements & payment are each rider's responsibility

Days Riding

Ride Date, Name  &  Trip Expenses

TOTAL PAID

Exp. date:

Check      or

Credit Card #

Print the completed form and fax to 530-672-3672  or mail it to  P.O. Box 1474, San Andreas, Ca  95249   EMAIL: actrides@goldrush.com

Cancellations:  If you cancel out of a ride for any reason within 10 days of the ride date, there is a $25 cancellation fee & no refunds.

Personal Assumption of Risk and Waiver of Liability:  I know that when I participate in an any ACT ride and follow an ACT roll-chart or map I will encounter serious dangers and unsafe conditions without any warning and I could suffer serious injury or death.  Knowing this, I still want to participate.  By agreeing with this statement, I voluntarily take full personal responsibility for my own safety and for all liability, injury, harm, or any problems that may happen to me as a result.  I choose to do so without knowing to what extent any of that might be.  I promise to never make any claims whatsoever for any personal damages, injury, or losses associated with any ACT ride, roll-chart, or map regardless of the circumstances.  I know ACT offers no medical or liability insurance coverage for me.  I have read and understand this statement and certify my agreement by submitting my entry and signing up for an ACT ride, membership or ordering a roll chart from ACT.

FAX: 530-672-3672
PHONE: 530-672-3672
EMAIL: actrides@goldrush.com
ADDRESS:  P.O. Box 1474, San Andreas, Ca  95249