HOUR BIKE RACE REGISTRATION FORM ……FAX FORM TO: 706-486-4688 OR EMAIL TO: anita@durhamtown.com
TEAM NAME__________________________________________________
HELMET #_________________________ (DP STAFF ASSIGNS)
NAME OF ENTRIES: BIKE MAKE: BIKE MODEL: CC SIZE
1 ____________________________________________________________
2_____________________________________________________________
3_____________________________________________________________
TOTAL ENTRIES_____ X $55.00=$________
SPECTATORS_______X $10.00=$________
GRAND TOTAL_$_____________
BY FAXING OR EMAILING, I COFIRM THAT THE INFORMATION ENTERED TO BILL MY CREDIT CARD FOR THE AMOUNT SHOWN (NO REFUNDS, NO EXCEPTIONS)
_______CUSTOMER INITIALS _________DATE
CIRCLE ONE
|
PRO CLASS/$75.00 |
IRON MAN OPEN |
IRON MAN OVER 40 |
2-MAN OPEN CLASS |
|
2-MAN B CLASS (AMATEUR) |
3-MAN OPEN CLASS |
3-MAN B CLASS (AMATEUR) |
OVER 30 CLASS |
|
OVER 45 CLASS |
YOUTH CLASS (15 & UNDER) 85CC, 2STR-250 CC 4STR |
FAMILY CLASS (2 OR 3 PERSON TEAMS) |
|
CARDHOLDER NAME__________________________ MC/VISA #____________________________EXP DATE___________________CVC/SECURITY CODE__________
SIGNATURE______________________________DATE___________
