FEE
$25 for Bike Rider (Per Bike)
$10 for Car Rider (Per Car)
       
Biker or Car Driver Name
Additional Rider
Additional Rider
Additional Rider
Additional Rider
Address
City
State
Zip
Phone
Email
T-Shirt Size
Additional Notes
       
In consideration of this registration entry, I/We waive any claims for myself and my heirs against officals, sponsors, and volunteers of this event for injury or illness which may result directly or indirectly from my participation. I/We further state that I/we am/are in proper condition to participate in this event. I/We give permission to authorize emergency treatment if needed. I/We will permit the use of my/are name and/ or picture for any broadcast, telecast, or other account of this event.

This event will occur at a later date if conditions do not permit. We still reserve the right to cancel this event in extremely severe circumstances. If this event is cancelled, you may request a refund or tax-deductable contribution statement.
I agree
 

Full Name


Phone (Optional)


Email


Comments



 

 

Site Design by Seven Creative Media Group