York Cancer Center Bike Hike Registration Form

Individual Participant or Team Leader
Address
City, State & Zip	,
Home Phone
Work Phone
Email
Team Members	Add to List
Payment Information
Entry Fee	$10.00
Card Type	Visa Mastercard Discover
Card Number
CVV Number
Card Holder
Expiration Date	1 2 3 4 5 6 7 8 9 10 11 12  / 2010 2011 2012 2013 2014 2015 2016 2017 2018
Release: In submitting this form, I understand the following.  All participants under the age of 13 must be accompanied by an adult (18 or older).  I (we) hereby agree to absolve and hold harmless the York Cancer Center, corporate sponsors, cooperating organizations and any other parties associated with this Bike Hike event in any way, singly or collectively from and against blame and liability for any injury, misadventure, harm, loss, inconvenience, or damage suffered or sustained as a result of participation in this event.  I (we) also hereby consent to and permit emergency treatment in case of injury or illness.  I (WE) UNDERSTAND THAT A HELMET MUST BE WORN BY ALL CYCLISTS PARTICIPATING IN THIS EVENT.
Security Information All transactions are completed on our secure server. In secure mode, your computer and our server begin communicating, sending data back and forth in an encrypted format. The encryption features of browser software are exceptionally powerful and ensure the security of this data as it is transmitted to our server.   A browser in secure mode will display a URL address beginning "https://" rather than the standard "http://". The "s" stands for "secure." In Netscape Navigator (versions 3.0 and earlier), the broken key symbol in the lower left corner of your browser window will become a solid key in secure mode. If you're using Netscape Communicator 4.0 or higher, look for the padlock in the same space: it's open in standard mode and closed in secure mode. In Microsoft Internet Explorer, you'll see a padlock symbol at the bottom of your browser window when the browser is in secure mode.