Haddock Jack’s 6th Annual

“Haddock 100”

September 8^th, 2007

Rain Date September 9^th

924 Post Road/US Rt. 1

Wells, ME 04090

8:30 a.m. Shirt Pick Up

10:30 a.m. Ride

Registration Form

Print and fill out the information below. Please send $20.00 in cash, check, or money order made payable to “Haddock 100” along with this form to:

Haddock 100

P.O. Box 118

Wells, ME 04090

Name: ____________________________________________

Address: __________________________________________

City: _____________________State: _________ZIP: ________

E-Mail: ____________________________________________

Telephone: (_____)__________________________________

CHECK OFF THE FOLLOWING:

Rider: ______Passenger: _____Donor: ______

Shirt Size: (please circle size)

S___M___L___XL___XXL___XXXL___

The undersigned agree to indemnify, release and hold harmless Haddock Jack’s, its Principals, Agents and Employees from any and all claims stemming from or relating to the undersigned’s participation in the “Haddock 100”.

The participant agrees and understands that participation in the “Haddock 100” is voluntary and the participant’s choice and the Principals, Agents, and Employees of Haddock Jacks aren’t in any way responsible for any of the participant’s injuries or damages that may occur in the participation in the “Haddock 100”.

Date: _________ Read and Agreed to by: ___________________________