Rider's Name:__________________________________________________________________

Course Distance:__________km Contact Number:__________________________

I release, waive, and hold harmless Jesters Charity Bike Ride and/or their officers and employees of all claims, losses, damages or expenses which may arise during or in conjunction with my participation in the Jesters Charity Bike Ride conducted by Jesters Charity Bike Ride at Pattaya city or other locations in Thailand including any claims for damage caused by the negligence of any of them, together with any costs including legal fees that my be incurred as a result of such claim whether valid or not.

I have read and approved the above and agree to all conditions.

Signed:_______________________________________________________________________

Date:_________________________________________