'

Printable Registration Form

Please, one form per rider.

Registration Form (PLEASE PRINT NEATLY) Ride Fee(s):

Name ______________________________

Address ____________________________

City _____________ State ____ Zip _______

Phone (____)________________

eMail ________________________________

Ride Distance (please circle):

10     30     68     100

T-shirt Size. q M   q L   q XL

TOTAL AMOUNT ENCLOSED: $ _______
Make checks payable to WRCC or White River Cycle Club
Adult Pre-registration
Postmarked by 07/01/10
(Includes meal ticket and T-shirt)
q$25.00
Late or "Day of" Registration
(Includes meal ticket)
q$30.00
 
Children Under 16 Preregistration
(must be accompanied by an adult)
Postmarked by 07/01/10
(Includes meal ticket and T-shirt)
q$15.00
Late or "Day of" Registration
(Includes meal ticket)
q$20.00

10 Mile Family Ride
(Does NOT includes meal ticket or T-shirt)
q$10.00
per family

Extra meal tickets


$8.00

Extra T-shirts


$10.00

# of Meal Tickets ______  Total $ _______
Release Form
The undersigned hereby absolves and forever holds harmless all officers, members, organizers, individuals and groups of the White River Cycle Club and all municipalities through which its bike riding event, conducted this 7th day of August, 2010, from Elkhorn (place where ride starts) to Elkhorn (place where ride will end), from any liability or damages of any kind which any of the undersigned or their bicycles suffer as a result of participating in this event. The undersigned hereby certifies that he/she has read and understands this agreement.

Signature _____________________________

Date _____________________

Mail to:
White River Cycle Club
P.O. Box 242 • Elkhorn, WI 53121