Register for 2024 Rollin' to Colon (Colon Cancer Task Force) - Job: Packet Pick-up day before

Please complete the registration form below to be considered as a volunteer for this event. You will receive a confirmation email if you are assigned as a volunteer.

Registration Information

Please enter your information into the fields below. Required fields are marked with *.

*First Name:
*Last Name:
*Gender:	Male Female
*Date of Birth:	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924
*Address:
*City:
*State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Postal Code:
*Secondary Phone:
*Email:
*Confirm Email:
*Emergency Contact Name:
*Emergency Contact Phone:
Shirt Size:	Youth Small Youth Medium Youth Large Youth XL Small Medium Large Extra Large XX Large 3x

Alternate Job Preferences

Alternate Job Preference #1:	Packet Pick Up / Day of Registrations Post Event Tent SAG Stops - 2nd Shift SAG Stops - Early Shift Tear Down & Clean up Post event lunch in DC West Cafeteria
Alternate Job Preference #2:	Packet Pick Up / Day of Registrations Post Event Tent SAG Stops - 2nd Shift SAG Stops - Early Shift Tear Down & Clean up Post event lunch in DC West Cafeteria

Registration Waiver

I know that riding a bike on an open road is a potentially hazardous activity that could cause injury or death. I will not enter and participate unless I am medically able and properly trained, and by my signature, I certify that I am medically able to perform this event, and am in good health, and I am properly trained. I agree to abide by any decision of an official relative to any aspect of my participation in this event, including the right of any official to deny or suspend my participation for any reason whatsoever. I assume all risks associated with riding in this event, including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic, and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver ad knowing these facts and in consideration of your accepting my entry, I, for myself and anyone entitled to act on my behalf, waive and release the Rollin’ To Colon, Great Plains Colon Cancer Task Force, Douglas County, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

* I fully understand and accept all conditions in this waiver.

Please Sign Below

Your electronic signature is the online equivalent of your ink-on-paper signature, and can be provided by typing your name where indicated. The electronic signature will signify your understanding, acceptance, and authorization to accept the conditions of this legal document, including the following statements:

• I have read, have understood, and do accept the agreement above.
• I understand that this is a legal document with effects that I approve and authorize.
• The registrant is the person(s) whose name is submitted as the recipient of the goods and services provided as a result of this transaction.
• I am authorized to agree to the terms of this document on behalf of the registrant.
• If the registrant is under 18 years of age, incapacitated, or mentally challenged, I assert that I am the parent/legal guardian or otherwise authorized to execute a legally binding agreement on behalf of the registrant.

• *Signature:

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You are encouraged to keep a copy of this agreement for your records. This agreement was generated at 10:50:03 PM EDT on 5/16/2024.
Click here to print the agreement.