Please read carefully, sign, and return with registration form. In consideration of the acceptance of this application, I hereby, for myself, my heirs, executors, administrators and assigns, and anyone entitled to act on my behalf, release and discharge the sponsors, directors, officials, employees and volunteers, from any kind of illness or damages suffered by me as a result of my participation in, or traveling to or from the Tour de Coal ride.

I know and understand that bicycling is potentially hazardous. I should not enter the Tour de Coal unless I am medically able and properly trained. I assume all risks associated with riding the Tour de Coal including falls, contact with other participants, the effect of weather, traffic, and conditions to roads; all such risks being known are appreciated by me. I realize that bicycling is a strenuous activity which requires proper physical conditioning. I do hereby certify that I am in such physical condition and in good health. I agree to wear all appropriate equipment, including a helmet at all times while riding the Tour de Coal.