Tri Kappa's Annual Metric Century Bike Tour Registration Form 2009 Tour de Max Saturday, May 16, 2009

Please complete this form, print it, and mail it to the address below. You must also sign and mail the Waiver of Claim.

Name:

Address:

Phone: --

E-mail Address:

Emergency Contact: Phone: --

Name of Rider Age T-Shirt Size Route* Fee**

--- Adult Medium Adult Large Adult X-Large Adult XX-Large --- 10 Mile Ride 30 Mile Ride 63 Mile Ride $ $20 $25

--- Adult Medium Adult Large Adult X-Large Adult XX-Large --- 10 Mile Ride 30 Mile Ride 63 Mile Ride $ $20 $25

--- Adult Medium Adult Large Adult X-Large Adult XX-Large --- 10 Mile Ride 30 Mile Ride 63 Mile Ride $ $20 $25

--- Adult Medium Adult Large Adult X-Large Adult XX-Large --- 10 Mile Ride 30 Mile Ride 63 Mile Ride $ $20 $25

Grand Total

* Routes: see Tour de Max Homepage for description

** Fee $20 per person received before 5/1/09

$25 per person received after 5/1/09

Children 12 and under ride free with adult, t-shirt not included

to Waiver of Claim

to Tour de Max Homepage

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