Name:
Address:
City:
State:
Phone:
E-mail:
Zip:
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Age on Race Day:
All credit card payments are received on line through Pay Pal, a reputable and secure payment center. No entity or individual is given access to your credit card information other than Pay Pal - not even Energy2Action. Please note that you will be charged $1 for processing through PayPal.
Want a mail-in Registration Instead?
Which Time Trial Are You Entering?:
Please give an estimate of your
average for the time trial:
(This allows us to seed riders according to their anticipated speed)
In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, volunteers, organizers, City of Shelbyville, The County of Shelby, and Energy2Action, LLC, for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event. I understand and acknowledge that participating in this cycling event may expose me to dangers from both known and anticipated risks. I understand that the course is NOT CLOSED TO TRAFFIC and that I could be at risk from traffic, other cyclists, bad weather, wet road, pot holes and rough terrain along the course. I acknowledge that some sections of this bike course may cause me to encounter dangerous situations and may contain areas where I will be at risk of tripping and falling or wrecking. I attest and verify that I am physically fit and have sufficiently trained for the completion of this event and my physical condition has been verified by a licensed medical doctor. I understand that this event may be canceled or delayed for any legitimate purpose or reason and that my entry fee will not be refunded under those circumstances or for any other reason. Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
Energy2Action
Time Trial Series
April 16, 2011
May 14, 2011
June 11, 2011
July 23, 2011
All Saturday mornings
7:00 a.m.
(Except the April 16th TT is 12 Miles and starts at 9:00 a.m.)
2630 S. Miller Street, Shelbyville, IN 46176
Are you registering yourself or someone else?
If someone else, what is your name?
Pre-registration for the May TT is closed
Riders can register on Race Day for $20
