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Name
*
$
First Name
Last Name
$
One Time
Recurring
Address
*
$
Address Line 1
Address Line 2
City
State
Zip
$
One Time
Recurring
Participant Date of Birth
*
$
$
One Time
Recurring
Participant Email
*
$
$
One Time
Recurring
Participant Phone
*
$
$
One Time
Recurring
Emergency Contact Name and Phone
*
$
$
One Time
Recurring
T-Shirt Size
*
None
Small
Medium
Large
X-Large
XX-Large
$
$
One Time
Recurring
Participants T-Shirt Size Selected (Small, Medium, Large, X-Large, XX-Large)
Bike Ride (Must Enter 1)
*
$
$
x $60.00
One Time
Recurring
Must Enter 1. Can only pay and register one participant at once in one session. Please fill out the form a second time for a second rider.
Yes, I'd like to cover the 3% processing fee.