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.
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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