Print Out a Registration
Please print out a registration and bring it with you the day of the event or mail it in. (
PDF
)
Register Electronically
First Name:
A value is required.
Middle Name:
Last Name:
A value is required.
Racing Age
(as of December 31, 2010)
:
A value is required.
Street Address:
A value is required.
City:
A value is required.
State:
A value is required.
Zip Code:
A value is required.
Phone:
A value is required.
Email:
A value is required.
Invalid format.
Emergency Contact Name:
A value is required.
Emergency Contact Phone
A value is required.
Event Selection:
High Water Hill Climb ($25.00)
10 Mile Timed Ride ($25.00)
6 Mile Poker Loop ($25.00)
High Water Hill Climb & 10 Mile Timed Ride ($50.00)
High Water Hill Climb & 6 Mile Timed Ride ($50.00)
10 Mile Timed Ride & 6 Mile Poker Loop ($50.00)
All Three Events ($55.00)
Please make a selection.
Additional Poker Hands ($10.00 per hand):
Must be a Number.
T-Shirt(s) ($20.00 per shirt):
Number of Shirts
Size of Shirt
Youth Small
Youth Medium
Youth Large
Small
Medium
Large
Donations are Appreciated:
Invalid format.
Entry fee includes USA Cycling insurance
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