Alpine Community Center

a grassroots local non-profit
25184 Webster Avenue
Monroe, OR 97456

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Alpine Century Ride > Alpine Century Registration


Alpine Century Registration

All riders pay $40

All riders who pre-register before
August 11 are entered into a
drawing for fabulous prizes!

More about the drawing...

Alpine Century Ride

Welcome Riders!

Sunday, August 18, 2013

 

Pre-register
by August 11, 2013

To pre-register by mail, print and fill out the form below on this page.

Register for Alpine Century in Monroe, United States  on Eventbrite

 

 

Print this page, fill it out for each rider, and mail the forms with your check or money order for $40 per rider to:

Alpine Century Ride
25776 Alpine Rd.
Monroe, Oregon 97456

Pre-registration Form

 

Name (Please print clearly):____________________________Age:_____

  

Address:________________________________State:____ Zip:_______

 

Email:_____________________________________________________

 

Phone:_____________________________Cell:____________________    

 

Emergency Contact (Name):____________________________________

 

Emergency Contact (Phone):____________________________________

 

Are you allergic to anything?

_________________________________________________________

Any special medical needs?

_________________________________________________________

Please enter me in the drawing:_____Yes _____No

 





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