NAME: _________________________________ ADDRESS: _________________________________   _________________________________ PHONE: _________________________________ E-MAIL: _________________________________ EMERGENCY CONTACT NAME: _________________________________ ADDRESS: _________________________________   _________________________________ PHONE: _________________________________

ROUTE: ___ 7 ___ 25 ___ 50 (Half century) ___ 62 (Metric century) T-shirts are $10.00. To guarantee a t-shirt in your size, please register by April 1. Shirts can also be purchased the day of the ride, while supplies last. (Please indicate size and number). ____ S ____ M ____ L ____ XL PAYMENT ENCLOSED:__________ ($15 in advance; $20 day of event) Make check to: Mt. Vernon Fire Dept. Mail to: 27440 Mt. Vernon Road Princess Anne, MD 21853

Would you like information on the Delmarva Birding Weekend mailed to you? _____ E-mailed? _____________________

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT ("AGREEMENT"):
In consideration for being permitted to participate in any way in the 2005 Fish Hawk Festival Bicycle Tour ("ACTIVITY") on April 30, 2005, an event sponsored by The Mount Vernon Volunteer Fire Department and the University of Maryland Eastern Shore, I, for myself, my personal representatives, assigns, heirs and next of kin: 1. ACKNOWLEDGE, agree and represent that I understand the nature of bicycling activities and that I am qualified to participate in such Activity. I further acknowledge and accept that it is my responsibility to consult with my own personal physician about my physical health, fitness, and ability to participate in the Activity and will do so before participating in the Activity. I further acknowledge that the Activity will be conducted over public roads and facilities open to the public during the Activity and upon which the hazards of public roads and motor vehicular traveling are to be expected. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity. 2. UNDERSTAND that all participants in the Activity are required to wear BICYCLING HELMETS, and I agree to wear a bicycle helmet while riding a bicycle as part of any event connected with the Activity. 3. FULLY UNDERSTAND that: (a) BICYCLING ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ("RISKS"); (b) these Risks and dangers may be caused by my own actions, or inactions, the actions or inactions of other participants in the Activity, the actions or inactions of third parties, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASED PARTIES" NAMED BELOW; and (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS AND DAMAGES I incur as a result of my participation in the Activity. 4. HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS The Mount Vernon Volunteer Fire Department, its administrators, officers, volunteers, staff, agents and employees; The State of Maryland, The University System of Maryland, and The University of Maryland Eastern Shore, and their administrators, officers, volunteers, staff, agents and employees; other participants; and any other sponsors, advertisers and, if applicable, owners and leasers of premises on which the Activity takes place (each considered on the "RELEASED PARTIES" herein) FROM ANY AND ALL LIABILITY, CLAIMS, LOSSES OR DAMAGES ARISING FROM OR RELATED TO MY PARTICIPATION IN THE ACTIVITY, INCLUDING BUT NOT LIMITED TO THE ACTS OR OMISSIONS OF THE RELEASED PARTIES AND INCLUDING BUT NOT LIMITED TO NEGLIGENT RESCUE OPERATIONS.

I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be complete and unconditional release of liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid that the balance, notwithstanding, shall continue in full force and effect.

I affirm and certify, under penalties of perjury, that I am over 18 years old and competent to execute this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT.

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Participant's Signature

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Signature of Parent/Guardian (if under age 18)

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Date