Knoxville Fall Classic Double Century Ride Application - Saturday September 30th, 2017

Entry Fee: $120.00
You are not officially entered until you have paid.
We may cancel your application if we have not received payment within one week after you submit your application.

Optional contribution to the Tom Milton Memorial AED Fund

Check-in is at Pena Adobe Park, 4699 Pena Adobe Rd, Vacaville, CA 95687
Friday evening between 5 & 8 or Saturday morning between 4:30 & 6:30.
You will be required to sign a waiver at check-in prior to riding.

Rider Information - Note: Fields marked with a red asterisk (*) are required.
First Name* Middle Name
Last Name*
Gender* Male   Female  
Birthdate*
eMail*
Address*
City* State* Zip*
Phone #* Alternate Phone #:
Emergency Contact Name* Emergency Phone*
Tandem Partner:
 Entry Fee. Please only change if you are utilizing a volunteer credit. 
 Tom Milton Memorial AED fund pledge amount. 
 Breakfast prepay (recommended $10/person). 
 Total Due. 
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