Main Rider First Name:
  Last Name:
  Street Address:
  City:
  State:
  Zip Code:
  Phone:
  E-mail:
Emergency Contact Full Name:
  Phone:
Second Rider Full Name:
  Phone:
     
First
T-shirt






Second
T-shirt






   
 
   
       
 
Instructions:

Registration Form
$30 Individual Rider Fee
$50 Couple Rider Fee

At the same time that you register please make payment to our PayPal donation site with your Visa, MaterCard, Discover or American Express by pressing the Payment Button.

You will be required to sign a Waiver of Liability Statement the day of the event.
Thank You.