2015 Registration form

Registration Form - STOKR 2015
SATURDAY & SUNDAY, MAY 9 & 10, 2015
This year entry to STOKR will be a lottery system. For those of you who wish to ride with particular friends, gather your
applications and money due and include UP TO 10 hopeful riders in one envelope. We will not be looking at postmarks.
Applications received on or before March 10 will be entered in the random drawing. If you don't get in, your check will be torn
up. If you would want your check returned, enclose a self-addressed stamped envelope.
Name (print): _________________________________________________________________________________
Mailing address: _________________________________________________ Phone: _______________________
City/State/Zip: ________________________________________________________________________________
Emergency Contact: _______________________________________________ Phone: ______________________
Email address for confirmation purposes ___________________________________________________________
Ride Options:
Check Option & enter price in Registration Fee
____ Option 1 - Ride both days, May 9 & 10 - $60
Saturday Ride, May 10 (check one)
___ 98 Mile Ride
___ 45 Mile Ride
____ Option 2 - Ride Saturday May 9 only - $55
(check one)
___ 98 Mile Ride
___ 45 Mile Ride
____ Option 3 - Ride Sunday, May 10 Only - $25
Registration Fee (see options)
STOKR t-shirt
____ Size S @ $15
____ Size M @$15
____ Size L @ $15
____ Size XL @ $15
____ Size XXL @ $17
____ Size XXXL @ $19
Optional Donation to
Habitat for Humanity
_____ I would like to work on the
Habit House on Friday, May 8
Please make check payable to: KVP Habitat for Humanity and mail to: STOKR, 1020 Idaho Ave, Libby, MT
59923. Cancellations received by April 26 will be refunded $20. The vacancy can only be filled from the wait list.
CANADIAN RIDERS - Your payment must be an international money order or a check drawn off of a US
Waiver/Release Form
I understand a helmet is required to be worn at all times while riding in the Scenic Tour of the Kootenai River (STOKR).
I agree to abide by the safety precaution requirements and all other rules for STOKR presented to me by the Kootenai Valley Partners Habitat
for Humanity. I agree to indemnify and hold harmless Kootenai Valley Partners Habitat for Humanity from all cost, expense and liability
arising out of my participation in STOKR. I hereby waive all claims for damage or loss to my person or property which may be caused by any
act or failure to act by Kootenai Valley Partners Habitat for Humanity, its officers, agents, or employees arising directly or indirectly from my
participation in STOKR, and I hereby assume liability for any loss, damage or other liability fromSTOKR. I give my permission for medical
release should I be involved in any accident or health damaging situation, and should I require treatment.
Participant's Signature ___________________________________________________ Date _______________________
Participant's under 18 years of age must have this additional waiver/release form signed by a parent or guardian
I have read and understand the complete waiver/release form, and the rules of STOKR. I request that my son/daughter be allowed to ride in
STOKR. I understand that children under 18 years of age must be accompanied by an adult. I explained the rules to my son/daughter and
agree that Kootenai Valley Partners Habitat for Humanity, it's officers, agents, or employees will not be responsible for my son/daughter while
riding STOKR. I also give my consent to the medical release clause in the completed waiver/release form.
Parent or Guardian's Signature ______________________________________________Date _______________________