Rider Waiver of Liability
for 2015 Sam’s Ride for Peace

Rider’s Name (Please Print):  ______________________________________________

Address: _______________________________________________________________
                                                             City/Town                          State                       ZIP  

Home Telephone: _______________________  Cell Phone: _____________________
E-mail Address: _________________________________________________________
Emergency Contact Name/Phone Number:  __________________________________

The 2015 Sam’s Ride for Peace will start at the Bell Tower on the NC State campus (2100 Hillsborough St., Raleigh) at 8:30 a.m. on Saturday, May 9. Riders will travel to the NC State Capitol at One East Edenton Street. After a brief stop, riders will continue their journey, arriving in Washington DC on May 16.

Helmets will be required for all riders.

Riders will be responsible for their own food and lodging. Tent camping and preparing one’s own food is an option for riders, as well as local hotels and restaurants. Sam’s Ride personnel will inform riders of options for lodging at each overnight stopping point and, insofar as possible, will make necessary reservations. Riders will be responsible for covering the cost of their lodging and food, except in those cases in which a local organization is preparing and offering meals.  If you will be needing financial assistance with lodging and/or food, please let Sam know prior to the start of the ride.

2015 Sam’s Ride for Peace will provide shirts or vests, and drinks and snacks at rest stops along the way. 2015 Sam’s Ride for Peace also will provide a truck carrying bike parts to help with needed repairs.

Riders will be required to sign a waiver relieving Americans for Peace of negligence and complete liability.
Riders under the age of 18 will be required to provide the signature of their legal parent/guardian.



Rider’s Name (Please Print): ______________________________________________

I wish to participate in the event organized as “2015 Sam’s Ride For Peace, benefiting Americans For Peace.

I understand that during the ride I will be using public streets and other public and private facilities where hazards may exist. I voluntarily agree to accept all risks associated with the ride including falls, effects of weather, and traffic accidents that may result in serious injury or death. I agree to wear a properly fitted, adjusted and certified ASTM, ANSI, CPSC or SNELL helmet while riding.

In consideration for my being permitted to participate in this ride, I for myself and anyone entitled to act on my behalf, waive and release, in advance, any and all claims for injuries and damages I may have against the Americans For Peace, all sponsors, hosting communities and all persons employed by or acting on their behalf which may hereafter accrue to me as a result of my participation in this ride even though liability may arise from negligence on the part of the persons or entities being released or because of their possible liability without fault. I understand and agree that this Waiver and Release is binding on my heirs, assigns and legal representatives.

I understand the organizers of this ride are relying on my assurance to them that I am physically capable of completing this event. If I am aware of or under treatment for any physical infirmity, ailment or illness, my medical care provider knows of and has approved my participation in this event. If injured, I consent to receive emergency medical treatment.

I have carefully read this Waiver and Release and fully understand its contents. By signing below, I agree to all of its terms and conditions, and also agree to abide by the state vehicle code and the staff’s and/or ride leader’s instructions.
Signature of accompanying parent or guardian is required if the participant is under 18 years of age.
1. Print Name __________________________ 2. Signature: _______________________
3. Address: ______________________________________________________________
                                                             City/Town                          State                       ZIP  

4. Home Telephone: _______________________  Cell Phone: _____________________
5. E-mail Address:  _______________________________________________________

Please return completed forms to Carol Lorenz at lorenzc@mindspring.com OR mail to 1812 Ram’s Way, Hillsborough, NC 27278, OR bring with you to the ride launch on May 9.