2010 Pre-Registration Form for Njrando Events

[admin]

NJ / NYC Brevet Series - 2010 Pre-Registration Form
Name of Event:________________________________________
Last Name: __________________ First Name: ________________
RUSA #:________ DOB: ____________ Gender:__________
Address: _________________________________________________
City: _______________________ State and ZIP: ________________
Home Phone: _________________ Cell Phone: _________________
Affiliated Club: __________________ Bike Type: _________________
Emergency Contact: _________________________________________
Contacts Phone: ________________________________
E-Mail Address: _______________________________________
Please mail this completed form together with your entry fees, checks payable
to Katie Raschdorf, 5 Blanchfield Court, Ho Ho Kus, NJ 07043
or use Active.Com for payment & E-Mail completed form to rba@njrando
[copy and paste completed form into RBA's email and list entering event(s)]
Make Payment or mail check 5 days before event or pay $10 surcharge at start
NOTE - No Fee for Practice Rides