2023 Verde Valley Bike to Work Week Survey

1.Name (First and Last)

2.Email

3.Biking to work is more fun as a team! Participants can choose to align themselves with a team either by where they reside or where they work. Teams will be limited to 10 participants.

Other (please specify)

4.I was encouraged to sign up by

5.Yavapai County Community Health Services (Organizer) are not responsible for any bodily injuries (including death), property damage, losses, expenses or harm that may occur by participants in Bike to Work Week. By agreeing to participate in logging your bike-to-work week activities from May 15, 2023, through May 21, 2023, you are assuming all risk associated with bicycle riding and hereby waive, release and forever discharge any and all claims against Yavapai County, Yavapai County Community Health Services, and the Cottonwood Bicycle Advisory Committee for any and all bodily injuries (including death), property damage, losses, expenses or harm, whether known or unknown, which may arise during Bike to Work Week, regardless of whether or not caused in whole or in part by the alleged or actual negligence or other fault of the Organizers.(Required.)

I agree to indemnity and hold Yavapai County, Yavapai County Community Health Services (organizers) harmless from any and all claims, liabilities, damages, costs, losses, or expenses (including but not limited to reasonable attorney fees and other litigation cost and expense) incurred by Yavapai County, Yavapai County Community Health Services, and the Cottonwood Bicycle Advisory Committee as the result of any claims, lawsuits or administrative authority that I (or anyone claiming by, under or through me) may file against the Organizers to recover any and all liabilities, damages, costs, losses or expenses which arise during or result from my competing, officiating, or participating in Bike to Work Week, regardless of whether or not caused in whole or in part by the alleged or actual negligence or other fault of the Organizers.

I acknowledge that I have read the above

2023 Verde Valley Bike to Work Week

Bike to Work Week begins Monday, May 15th and concludes on Sunday, May 21st.