|TEAM MANGO RACES
VENTOURIST BIKE CAMP
VAISON le ROMAINE, FRANCE
JUNE 18th - 25th
|YES___ Sign up for TEAM MANGO RACES Club Membership for 2017 Ventourist Bike Camp in PROVENCE Region of
FRANCE. Touring the MONT VENTOUX area and Surrounding Climbs and Passes
CAMP DATES: June 18th - 25th. 7-Day French Touring Camp $1399.
All Hotel Accommodations and Meals included 7 days. Marseilles Airport Pick-Up & Drop-Off Available
LAST NAME ________________________________________ FIRST_____________________________________
Address Line 1: _______________________________________________________________________________
Address Line 2: _______________________________________________________________________________
State/Provence: __________________________________________ ZIP/COUNTRY CODE: ___________________
Contact Phone Number: (__________) ____________________________________________________________
Email Address: _______________________________________________________________________________
D.O.B. _________ / _________ / _________ M/F: _____
Emergency Contact: ___________________________________________________________________________
Emergency Contact Number: (_________) _________________________________________________________
Bicycle Rental (To Reserve the Bicycle): YES____ NO____ **Average Hours Riding Weekly ________Hrs.
Riding Skill Level: Racer & Expert_____ /// Above Average_____ /// Average _____ /// Novice_____ (Sorry No Beginners)
| CLUB MEMBERS RELEASE
_____ I AGREE to receive mailings from Team Mango Races vendors which does not obligate me to purchase any athletic products. I
GIVE FULL PERMISSION for free use of my name, voice, or picture in any broadcast, telecast, advertising promoting or other account of
this TMR Camp.
_____ I UNDERSTAND that participating in an Ultra Distance Bike Camp and Race is potentially hazardous activity and can result in
_____ I ATTEST that I am physically fit for signing up to become a Team Mango Races Bicycle Camp Club Member. Which I can assure
Club Members/Staff my ability operating a bicycle and my physical condition in more than sufficient for Controlling and Racing my
Bicycle in Southern France.
_____ I AM aware of and expressly assume all inherent risks associated with participating in this TMR Camp event, including, but not
limited to falls, contact with other participants, spectators, pedestrians, animals, any objects, the effects of weather, including high heat,
and extreme cold, traffic, and the conditions of French roadways.
_____ IN CONSIDERATION: of your accepting this CLUB MEMBERSHIP, I for myself and anyone entitled to act on my behalf, waive and
release from any and all claims for injury and damages I may have against TEAM MANGO RACES, the State of Hawaii, the United States,
LA CANNIBALE event or DIRECTORS, the French People or Local/Regional Government
____ I CONSENT to Medical treatment which may be advisable in the event of illness or injury suffered by me during this Bicycle Camp/
La Cannibale event and agree to pay for the costs of my Medical treatment.
|LA CANNIBAL // VENTOURIST CAMP REGISTRATION DEADLINE MAY 15th 2017
$500 CHECK/MONEY ORDER NON REFUNDABLE DEPOSIT REQUIRED SECURING CAMP RESERVATION
MAIL YOUR COMPLETED APPLICATION SIGNED ALONG WITH THE $500 NON REFUNDABLE DEPOSIT TO:
CANNIBAL c/o TEAM MANGO RACES PO BOX 16 HOLUALOA, HAWAII 96725
|1-Week Ventourist Camp....................$1399USD
||2-Week Cannibal/Ventourist Camp........$2799USD
SIGNATURE: ______________________________________________________________ DATE: ______________