Category:
Solo $55
Tandem $75

Team Name

Name

Address

City

State OREGON ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DC FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Outside of U.S.
Zip

Phone

Email

Category A Group Pro 1 & 2 B Group 3 C Group 4 & 5 D Group Women 1 & 2 E Group Women 3 & 4 F Group Masters Men 30-39 F Group Masters Men 40-49 F Group Masters Men 50-59 F Group Masters Men 60+ G Group Masters Women 30-39 G Group Masters Women 40-49 G Group Masters Women 50-59 G Group Masters Women 60+ H Group Tandem Men H Group Tandem Mixed H Group Tandem Women I Group Recumbent
Gender: Male Female
Date of birth (MM/DD/YY)

OBRA # (if you have one)

T-Shirt Size Small Medium Large X-Large

Release of Liability (read it here)
I hereby certify that I have read the Accident Waiver and Release of Liability and, I understand its content.

If you are under 18, a parent or guardian will need to fill out this form and mail it in, or you can bring it to the race.

General Questions or comments