| Name of Participant | Age | * Release Signature (If under 18, parent or guardian must sign) |
* Release: I realize that I am participating in the "Crane Cruise" for my own enjoyment and I understand the risks that I am incurring in this undertaking. I further understand that I will be riding on public roads that will be carrying their normal traffic. In signing this form for myself and for the above named participant (if he or she is under 18 years of age), I understand and agree to absolve all sponsors and organizers, be they individuals or organizations, singly and collectively, of all blame for any injury, harm, loss or inconvenience suffered as a result of taking part in the "Crane Cruise" or any activities associated with said event.
| Registration Fees | Quantity | Until Oct 15th | After Oct 15th | Total |
| Per Rider | $11.00 | $13.00 | ||
| Per Family | $25.00 | $30.00 | ||
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T-Shirt Order: (Long Sleeve Only, $15.00 Each)
| Small | Medium | Large | X-Large | XX-Large |
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Overall Totals:
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Make Checks Payable To: Medaryville Lions Club c/o Mick Capouch 16747W 200N Medaryville, IN 47957 |
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Directions: From the North take US Highway 421 to the town of Medaryville. The Lions Building is located on Main Street East of 421. Medaryville is approximately 50 miles south of Michigan City. From the South take US 421 North to the town of Medaryville.The Lions Building is East of 421. Medaryville is located approximately 50 miles north of Lafayette.
The Ride: Sat, Oct 27th: Ride lengths will be from 12 miles to 50 miles on flat paved rural roads. Helmets are required. Registration will be from 8AM until 1 PM at the Lions Building. Maps will be available. The Sandhill crane presentation will be at 5 PM at the Jasper-Pulaski Fish and Wildlife Refuge. Questions call Mick Capouch at (219) 843-4491 or e-mail at: mick@capouch.net