RAT BEACH BIKE TOUR - SEPTEMBER 22, 2012
RIDER REGISTRATION FORM
ratbeachbiketour.com

If you would like to register and pay with cash or check please print the registration form and waiver. Fill out the registration form, sign the waiver and mail to P.O. BOX 152, Torrance, California, 90507. Remember no registration will be accepted without a signed waiver form.

Personal Information:

Name______________________________________________Date of Birth____-____-____ Sex____M____F
Address___________________________________City______________________State_____ZIP__________
Phone_____________________E-Mail_____________________________________________________________

Regular Registration 62 miles, 31miles, 15miles. (Must be paid before August 24, 2012)

$55.00__________Tandem $80.00_______

Late Registration 62 miles, 31 miles, 15 miles. (Payments after August 24, 2012):
$60.00___________Tandem $85.00________

Tee Shirt Size ___S___M___L___XL___XXL (XXL add $2.00)
Additional Tee Shirts $15.00___S___M___L___XL___XXL (XXL add $2.00)

Rat Beach Bike Tour Jersey $65.00 Size ___S___M___L___XL___XXL (XXL add $5.00)

Lunch included with Registration - Ruby’s Hamburger, Fries, Coke. Highly Discounted Optional Lobster Lunch add $15.00 to registration_________

General Raffle. One (1) ticket included with Registration. Additional Raffle Tickets, 2 for $1.00, 10 for $5.00, 20 for $10.00, 40 for $15.00, 60 for $20. Number of Tickets_____=$___________

Payment Information:

Total Enclosed $______.____ Cash___Check___
Payable to: Rat Beach Bike Tour, P.O. Box 152, Torrance California, 90507

I HAVE SIGNED AND ENCLOSED THE LEGAL WAIVER FORM____YES_____NO

In Case of Emergency Contact:

Name______________________________________________Relationship_____________________________
Address________________________________________City_______________Sate_______ZIP____________
Day Phone_________________________________Night Phone___________________________________