It is strongly recommended to fill in this form on a desktop or laptop computer.

Your Name (required)

Preferred Name/Nickname (required)

Your Street Address (required)

City (required)

State (required)

Zip Code (required)

If your address is not in the USA, what is your address?

Telephone (required)

Your Email (required)

Gender (required)
—Please choose an option—MaleFemale

Shirt Size (required)
—Please choose an option—SmallMediumLargeX-Large2-XL3-XL

Emergency Contact for Person not travelling with you:

Emergency Contact Name (required)

Emergency Relation (required)

Emergency Contact Telephone (required)

I will be riding (required)
—Please choose an option—UprightRecumbentTandemTrikeEbikeNon-rider

I will be renting from provider (required)
—Please choose an option—NoYes

I am a vegetarian. (required)
—Please choose an option—YesNo

Vegetarian is the only additional menu option available.

Medical Conditions

Do you have any medical conditions you wish to share and make the tour aware of? (required)

I will be registering as (required)
—Please choose an option—SingleDouble

Fees:

Pricing is based on receipt of registration AND deposit. Mail-in registration/payment must be postmarked on or before date and payment made out to Pedal Productions. Checks made payable to any other name will be returned and your registration not processed. Online payment must be received on or before due date.

If registering for a double, who will you be sharing with?

At this boutique bed and breakfast, rooms only have one bed. If more than one person to the room, you will be sharing the same bed.
—Please choose an option—I Understand

Discounted rate for multiple riders dependent on receiving registration of other riders!

Note: Double rate only available to those sharing the same room.

Staff Appreciation: The volunteer staff will be working very hard to assure a wonderful time for all. At dinner the
last evening, staff appreciation envelopes will be handed out. Monies collected will be divided up equally among
the hard-working staff. 15%-18% of the registration fee per rider has become standard.

Deposit of 50% is required at time of registration. Remainder is due December 28, 2023.

Make check payable to Pedal Productions and mail to: Bubba's Pampered Pedalers; 1916 Pike Place Ste 12 #1470; Seattle, WA 98101

Please review the COVID policy, which can be found at: https://www.bubbaspamperedpedalers.com/covid-19

Please read carefully and fully understand before sending in your payment. This
cancellation/refund policy will be strictly adhered to. Please, DO NOT ask for exceptions to this
cancellation/refund policy, none can/will be granted for ANY REASON

• Due to contractual obligations, there will be no refund after October 1.

• This cancellation/refund policy must and will be enforced.

• If for any reason the tour is unable to start due to an Act of God, Natural Disaster or any other happening out of the tours’ control, a 100% credit will be issued for any future Bubba’s Pampered Pedalers’ event.

• If for any reason the tour, once started, gets interrupted before the ending location due to an Act of God, Natural Disaster or any other happening out of the tours control, no refund either in form of cash or credit will be offered.

• Trip insurance is available from various sources. The event will assist with processing a claim.

Again, the stated cancellation/refund policy will be strictly enforced with no exceptions.

Trip Insurance
Trip insurance to protect your investment is highly suggested. This like will direct you to sources for trip insurance. Review each choice to determine which options best meet your needs. For those making several trips per year, a yearly policy might be the most cost-effective option. https://www.squaremouth.com/23242

Please review the cancellation policy once again while deciding if trip insurance is an option you should consider.

By signing, you are fully aware of the stated cancellation/refund policy will and must be strictly enforced. You also understand trip insurance is available from various sources using the above link. If for any reason you must cancel the tour, or the tour must cancel once started for reasons beyond the tour's control, you understand the tour will assist in filling a claim with said insurance company. You agree not to contact the tour to ask for any exceptions to this cancellation/refund policy understanding no exceptions for any reasons will be made.

Full Legal Name (required)

I understand that this is a legally-binding e-signature (required)
Yes

Today's Date (required)

Please use mm/dd/yyyy format.

This waiver is a contract with legal consequences. Please read this carefully.

I, the undersigned, know that Space Coast Bike Tour is a potentially hazardous event, and attend it out of my own free will and choice. In choosing to attend Space Coast Bike Tour and any related events or activities, I fully accept and assume all risks, whether before, during or after Space Coast Bike Tour and/or related events or activities. These include, without limitation, risk of physical injury mental injury, mental stress, emotional stress, trauma, death, contact with other participants, communicable diseases, equipment failure, inadequate safety equipment, effects of weather including extreme temperature or conditions, traffic, contact with motor vehicles of all types and descriptions, collision with other riders or fixed or moving objects, the conditions of the roads, theft, camping and participating in events or activities along the route. All risks are known, understood, and appreciated by me. I waive any and all specific notice of the existence of risks. I agree that leaders and maps are provided for my convenience only and do not guaranty a safe route or trip. I shall assume and pay my medical and emergency expenses in the event of injury, illness or other incapacity regardless of whether I authorized such expense. I realize Space Coast Bike Tour requires physical conditioning and I represent that I am in sound medical condition capable of participating in the ride without risk to myself or others. I have no medical impediment that would endanger myself or others. I understand that situations may arise during Space Coast Bike Tour that may be beyond the control of sponsors, promoters and organizers. I will be solely responsible for the condition and adequacy of my bicycle, safety gear and riding equipment. I will ride safely within the limits of my own abilities, my equipment and the riding conditions and in a manner so as not to endanger myself or others. Knowing these facts and in consideration of my entry, acceptance, admission to and participation in Space Coast Bike Tour and its related events and activities, I, for myself and anyone acting on my behalf, waive, release, discharge, indemnify, covenant not to sue and agree to hold Space Coast Bike Tour, Bubba’s Pampered Pedalers, the staff of Bubba’s Pampered Pedalers, Bicycle Logistics and Touring, the staff of Bicycle Logistics and Touring any and all sponsors, communities, organizations, Space Coast Bike Tour, Bicycle Logistics and Touring and Bubba’s Pampered Pedalers employees-representatives-volunteers, agents-insurers-insurance brokers and successors of all above, harmless from any and all claims, demands and actions of any and every kind that I have, may have or may hereafter accrue against the released parties, directly or indirectly, arising out of or relating in any respect to my attendance or participation in Space Coast Bike Tour and its related events and activities, including, without limitation, litigation expenses, attorney fees, loss liability, damages or cost. My waiver and release of all claims, demands, actions and liability shall include, without limitation, any injury, damage or loss to my person or property which may be caused by any act, or failure to act, by the above identified persons and entities or sustained by me before, during or after Space Coast Bike Tour and its related events and activities. I agree to abide by all Space Coast Bike Tour rules and regulation. I waive my rights of privacy or publicity and grant permission to all of the forgoing to use any photographs, motion pictures, videotapes, recordings or other record of this event for any legitimate purpose. I further agree to indemnify and hold the parties released above harmless from any and all losses, damages, claims and expenses, including attorney fees, arising from or relating in any respect to my participation in Space Coast Bike Tour or its related events and activities. If I am a minor, my parent or guardian is also signing on my behalf and we both agree to be bound by the same terms of this agreement, waiver and release. If I am the parent or legal guardian of a minor child participant, I certify that the minor is in good health, qualified and in proper physical condition to participate in Space Coast Bike Tour and I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless all of the above released parties from all liability, claims, demands, losses or damages on the minor’s account incurred in connection with Space Coast Bike Tour or its related events and activities. I will indemnify, save and hold harmless each of the released parties from any litigation, expenses, attorney fees, loss liability, damage or cost that may occur as the result of any such claims in connection with the minor’s participation in Space Coast Bike Tour and its related events and activities. I have read, understand and agree to the cancellation/refund policy.

Full Legal Name (required)

I understand that this is a legally-binding e-signature (required)
Yes

OR if under 18 years of age, signature of parent or guardian

Double/Triple/Quad Occupancy
Space Coast Bike Tour

If registering for the discounted double/triple/quad occupancy rate, registrations for all riders must be placed together.

If registering as a double/triple/quad please be prepared to share the same bed.

The host lodging location B&B has no rooms with two beds.

• Wear a bicycle helmet at all time while riding

• Wear the tour provided safety vest at all time while riding

• Equip my bicycle with a rear blinking light of at least 100 Lumens and have light activated while riding

• Equip my bicycle with a white front light and have light activated while riding

• Have a rear facing mirror allowing me to see approaching vehicles

• Use standard hand signals announcing turns

• Not wear any type of headphones while riding my bicycle

• Not to talk on cell phone or text while riding my bicycle

• Obey all traffic signs and signals

• Ride defensively always being aware of other riders, vehicles, and pedestrians around me, never assuming what they are doing or what they are about to do.

• Point out road hazards and yell “Gravel” “Hole” “Glass” etc to riders around me

• Call out my intentions to riders; “Slowing” “Stopping” “Turning”

• Ride in single file when a motor vehicle is behind me

• Never ride more than two abreast and never be a trail hog giving other bicyclists plenty of room to safely pass

• Always ride as far to the right as safely possible

• Use common sense and be courteous towards motorists and other bicyclists

• If stopping for any reason, I will move completely off the roadway

• Call out “On your left” while passing a slower rider and never pass on the right.

• I understand and fully accept I can and may be removed from this tour, without refund, if I do not obey these safety rules.

• To be a smart, safe, and savvy bicyclist

• I understand and agree that I will not be allowed to ride on this tour without the above highlighted (bold-print) items being in place.

Full Legal Name (required)

I understand that this is a legally-binding e-signature (required)
Yes

Today's Date (required)

Please use mm/dd/yyyy format.

Bubba is including a bicycle jersey on this ride. The company making them is Sublimination Kings; the same one he has used for most of his other jerseys. View their sizing chart on their web page (https://sublimationkings.com/sizing/) to help you determine what size jersey will best suit you. ALL jerseys will have a flat hem with NO ELASTIC.

Determine whether you would like a men's or a women's cut and your size.

Name (required)

Type (required)
—Please choose an option—Men'sWomen's)

Size (required)

How will you be paying?
—Please choose an option—Credit/Debit CardCheck/Money Order Payable to Pedal ProductionsOther - Please note below!

Other - Please Describe:

Do you have any questions, comments, or notes for Bubba?

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