NUMB Ride 2019 Registration & Jersey Order Form

*First Name
*Last Name
*Address 1
*Cell Phone #
Home Phone #
*NUMB Ride Registration Fee

Please check the appropriate box and the questions for your choice will open.

Riders will have the option to pay your registration online by choosing the 'Pay Now' button once you've submitted your registration. The PayPal account is managed by Great Plains UMC, or send your check to: NUMB c/o Regina Bergman, PO Box 165, Elkhorn NE 68022  

NUMB RIder Registration ($60) 49 available
NUMB Rider Registration w/free rider voucher
Volunteer - I would like to volunteer and will not be riding
NUMB RIder Registration: There are only 49 available
*Preferred First Name for name tags
*Date of Birth
*Age (as of 6/23/2019)
*May all information be sent via email?

Please make sure to add and into your address book so that it does not go into junk mail.

United Methodist Church

Please indicate the Great Plains United Methodist church name and location you are affiliated with.

Saturday Optional Morning Ride

Please indicate if you will be there to ride on Saturday. Camping is available in McCook on Friday and Saturday evening. If you do not know at this time if you will be at the ride, you can let us know when the date gets closer.

No answer
*Type and make of bike.

This information is to help our mechanics have supplies available. If you are volunteering, please write volunteer.

*This is my first NUMB Ride!
If this is not your first how many NUMB rides have you participated?
*T-Shirts - Each rider and volunteer will receive one NUMB t-shirt upon registration.
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Additional T-Shirts - If you would like additional NUMB 2019 T-shirts they are $10 each -- $12 for XX-Large.
Adult Small ($10)
Adult Medium ($10)
Adult Large ($10)
Adult X-Large ($10)
Adult XX-Large ($12)
Donations to Hunger - Each rider is asked to raise a minimum of $100 donations to NUMB hunger projects. You will receive information on collecting these donations at a later time or you can make a donation now.
I would like to make a donation at this time to the hunger projects supported by NUMB 2019.

Please indicate how much you would like to donate. After you submit you will be given the option to pay via PayPal where you can make your confidential and secure fiancial transaction. You may also mail your donation to: NUMB c/o Regina Bergman, PO Box 165, Elkhorn NE  68022

Only number values are allowed
In case of emergency - please contact:


*Relationship to you:
*Best phone number for emergency contact:
I agree to the terms and conditions outlined below. (At ride check-in we will ask you to sign a paper release)

  I, the undersigned, freely acknowledge and realize the dangers in participating in NUMB ‘19 and fully assume all risks including but not limited to, collision with pedestrians, vehicles, other riders, and/or fixed or moving objects, the negligence of other riders, sponsors, promoters or drivers and dangers arising from falls, road surface, equipment failure, inadequate safety equipment, weather conditions, as well as the possibility of physical and/or mental trauma (or injury). I understand that the route requires bicycling on public roadways and in bad weather and that cyclists have been hospitalized and/or killed because of traffic mishaps that are either their responsibility or others’ responsibility, and I further agree that I will bear all expenses incurred in any such accidents.

  I realize that NUMB requires physical conditioning and I represent that I am in sound medical condition. I have no physical or medical impediment, which would endanger others or myself. I understand and agree that a situation may arise during NUMB which may be beyond the control of the sponsors, promoters, or organizers and agree to ride so as not to endanger either others or myself.

  I waive, release, discharge for myself, my heirs executors, administrators, legal representatives (including successors), any and all rights and/or claims which I have, may have, or may hereafter accrue to me against the sponsors and promoters of NUMB including the United Methodist Conference or other sponsors or affiliated organizations and their respective agents, officers and employees for any and all damages, injuries, or claims which may be sustained by me directly or indirectly arising out of my participation in NUMB

  Participant agrees to indemnify and hold the organizer harmless and to indemnify the organizer for all claims that may arise from the participant's Injuries or death or property damage caused by the simple negligence of the organizer.

  The above agreements and representations are my express understandings of the risks, and I assume these voluntarily and freely without coercion or duress. This agreement may not be modified orally and may not be waived in any respect. I accept responsibility for the condition and adequacy of my bicycle and agree to abide by the rules of NUMB relating to the wearing of a helmet as well as other organization requirements.

  I authorize the use of my name, photos or videos of myself to be used by NUMB or any associated organization for the purpose of promoting NUMB and I hereby disclaim any and all rights to such photos or videos. There is no time limit in hours, days or years that my photo image may not be used. I also understand NUMB will only use my photo or image in publicity related to NUMB.

Medical Training

Check if you have medical training, EMT, nurse, doctor, etc, and would be willing to help us out on the road or in camp with medical situations.

*Rider/Support information list.

By checking yes you give permission to include your name, address and email on a rider list to be given to all riders on NUMB 2019. If you check no - we will not include you on the list.

I am under 18 years of age.
Person responsible for minor on NUMB 2019

If you are a minor (under age 18), please list the person that will be responsible for you on NUMB 2019. This is required of all under 18 years of age.

Parent/guardian permission - for those riding under 18 years of age.

I have the permission and consent of my parent(s) and/or guardian to participate in NUMB 2019. I further agree that my parent(s) and or guardian(s) agree to the terms described above. A waiver will be sent to you to have both parents sign and bring with you to NUMB check-In.

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