Devil Mountain Double Century Ride Application - Saturday April 28, 2018
Entry Fee: $100.00 ($120.00 after March 31st)
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 the San Ramon Marriott, 2600 Bishop Drive, San Ramon, CA, 94583,
Friday evening between 6 & 8 or Saturday morning between 4 & 6.
You will be required so 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.
Total Due.
In the following field, please enter the word "quack". This will hopefully prevent automated hackers from submiting useless information. Sorry for the inconvenience...I wish these people would find a productive use for their talents.
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