Liv to Ride Two Up Registration

Rider Name *

First

Last

Rider's Phone *

Rider's Email *

Passenger Name *

First

Last

Passenger's Phone *

Passenger's Email *

Were you referred to ride? *

Yes
No

Referrer's Name *

First

Last

Referrer's Phone

How Are You Paying? *

Credit Card (preferred method) - please follow the link to pay on the next page.
Cash - Please bring to 502 W. Blvd. Rapid City, SD 57701
Check - Make checks payable to Black Hills Area Community Foundation. Please mail to: Rosemary Washnok 502 W. Blvd. Rapid City, SD 57701

*I hereby assign & grant Liv Hospitality the right & permission to use and publish the photographs/film/video/electronic representation and/or sound recordings made of me by Liv Hospitality. I hereby release Liv Hospitality & its entities from any and all liability from such use and publication. I authorize the reproduction, sale, copyright, exhibit, broadcast, electronic storage, and/or distribution of said photographs/film/video/electronic representation and/or sound recording without limitation at the discretion of Liv Hospitality and its entities and I specifically waive any right to any completion I may have for any of the foregoing. *

I have read & acknowledged the above disclaimer.

*To fully register your spot in the ride, payment must be received by the day of the ride. *

I have read & understand the above disclaimer.

*By participating in Liv to Ride, bikers acknowledge they are riding at their own risk. Liv to Ride and its affiliates are not responsible for any injuries, damages, or losses. Riders are solely responsible for their safety, equipment, and adherence to traffic laws. By joining, participants waive any claims against Liv to Ride for liability. *

I have read & understand the above disclaimer.

Two Up Rider Registration

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