2024 Bicycles International Glow Ride | Venice, FL

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Glow Ride Registration Form

Purchase before November 19th to get the T-shirt.... NO T-Shirt after 11.19.24

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Participant Information

Contact Email *

Participant First Name *

Participant Last Name *

Participant Birthdate *

Participant Gender *

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Female

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Street Address (w/Apt#) *

City *

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Phone *

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Emergency Contact *

Emergency Phone *

Make a Donation

We will be providing The Haven with FREE bicycles and repairs! Would you like to add to your donation?
click here, to learn more about this cause

Amount $

This year we will be donating to The Haven for the maintenance and purchase of new bicycles and tricycles for the program! And as always proving bicycles and maintinace to kids in need of assistance to be able to enjoy a bicycle.

Waiver *

                                           WAIVER AND RELEASE OF LIABILITY
This Release and Waiver of Liability (the “Release”) is executed by the “Participant” and, if applicable, in conjunction with the parent(s) or guardian having legal custody or legal guardianship of the Participant, in favor of Bicycles International.  For purposes of this Release, all references to Bicycles International and includes its employees, officials, agents, representatives and volunteers.  The Participant desires to participate in the above-described event and agrees, at his/her sole cost and expense, to indemnify and hold harmless Bicycles International from and against any and all liability, damages, claims and demands which may be imposed upon, incurred by or be asserted against Bicycles International and its officials, employees, agents and representatives as a result of or in any way connected with the participant’s participation in this activity.

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Is the participant 18 or older? *

18 or older Under 18

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