Tour of Cyprus 2012 Registration Form

Fields marked with * are required.

Team information (if you are riding with a team):

Team Name (if you are riding with a team)

Team Representative

Personal Information:

Participant First Name *

Participant Last Name *

Passport or ID Number *

Sex *

Male

Female

Date of Birth *

Contact Information:

Email Address *

Contact Telephone Number *

Street Address *

Post Code *

Town or City *

Country *

Participation Options:

Group *

Group A (road bike ride with time taking sections)

Group B (Ride for all. No time taking/race or competition)

Participation Package *

PARTICIPATION ONLY: €75

PARTICIPATION ONLY + 2 DINNERS: €105

PARTICIPATION with ACCOMMODATION in double room: €150

PARTICIPATION with ACCOMMODATION in double room + 2 DINNERS: €180

Who would you like to share a room with?

Additional Options (extra cost):

These are optional extras at additional cost. If you do not require any of these options, you may go ahead and submit payment, according to your choice above. If you do require one or more of these options, please submit the form and we will send you an invoice.

If you need additional accommodation in Cyprus please specify dates and total number of nights

Would you like transportation on 25 March from finish area in Paphos to Larnaca?

Do you have accompanying persons (not participating in the ride), that will follow the participant throughout the tour? If yes then type in their data.

Name of first companion (in same room)

Name of second companion (in same room)

Accompanying persons will need transportation from:

Nicosia to Larnaca (Stage 1)

Larnaca to Limassol (Stage 2)

Limassol to Paphos (Stage 3)

Paphos to Larnaca (after the finish)

Whom should we call in case of emergency?

Name *

Telephone Number *

Health Information:

Any health issues or medication we need to be aware of?

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Other Information:

T-shirt Size *

Any other information or request?

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Waiver and Indemnity:

Participants hereby acknowledge that they take part in the “Tour of Cyprus” (‘the Event’) and all functions and events related thereto entirely at their own risk.

Participants hereby agree for themselves, their executors, administrators, heirs, next-of-kin, successors and assigns to waive release and discharge and shall neither have nor institute any claims whatsoever against “Tour of Cyprus” or “Podilatokinisi Cyprus Cycling Association” (‘the Organizers’) and its directors, associates, trustees and shareholders (if any), local provincial and national governmental authorities, participating clubs, event sponsors and other involved organizations (‘the Entities’) and their employees, agents or contractors to the fullest extent permissible under any applicable law.

Participants hereby indemnify and hold harmless the Entities and their employees, agents or contractors from all liability and claims made by other individuals or entities as a result of any of the Participant’s actions during the Event.

This waiver and indemnity covers death, disability, personal injury, damage to and loss of property of a participant (including theft of or damage to a bicycle in areas under the control of the Entities and the Individuals) and is effective whether or not such death, injury, damage or loss may have been caused directly or indirectly or wholly or partly by any act or omission including negligence, of any of the Entities or their respective servants agents and contractors and will bind the heirs, executors and/or trustees of the estate of a participant.

Persons signing this indemnity as the parent and/or guardian of a minor hereby agree to such minor being bound by the foregoing waiver and indemnity, and do hereby further indemnify and hold harmless the Entities against any and all liability and claims by such minor to the extent if any to which such minor is not capable of waiving his rights as stipulated above.

Should liability be found to exist in respect of any one of the Entities for any reason then that liability shall not exist in respect of the other Entities unless specific grounds exist for liability on the part of the other Entity or Entities.

Declaration:

I have read and agree to abide by the Rules and Regulations and FAQ/Guidelines which I understand may change from time to time and be posted on the web site tourofcyprus.com. I have read and agree to the terms of the Waiver and Indemnity above.

I understand that the Event will involve prolonged strenuous activity and that I need to achieve an appropriate level of fitness in order to participate. Before the start of the Event, if I have any concerns whatsoever about my physical fitness or health, or any medical conditions that may affect my safe participation, I will consult my Doctor. I certify that I am physically fit and I hereby assume all the risks of participating in the Event.

If I experience any pain or discomfort during the Event I will immediately inform the Organizer. I agree to submit to any medical examination diagnosis or treatment administered by a suitably-qualified medical professional (‘Medical Professional’).

The medical information included on the entry form may be released by the Organizer to such Medical Professional as may be appropriate in the event of illness or an accident on the trip and I hereby consent to such medical treatment as may be deemed advisable and authorize the Organizer to notify my next of kin.

I understand that the Event may be filmed, photographed and recorded and hereby grant permission to the event organizers to use such images and recordings of myself.

I hereby certify that the information provided by me for this Event is true and correct.

I have read and agree with the above. *