Alpine Century Ride > Alpine Century Registration
Alpine Century Registration
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All riders pay $40
All riders are entered into a
drawing for fabulous prizes!
More about the drawing...
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Alpine Century Ride
August 11, 2012
200 Rider Limit
Pre-registration required
by August 4
To pre-register by mail, print and fill out the form below on this page.
Click here to register on-line.
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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 Road
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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