Registration - Main

Pacific Populaire
 

2014 PACIFIC POPULAIRE - April 6
PRE-REGISTRATION FORM
(Postmarked Thursday, March 28, or before)

Print entry and waiver. Mail to:

BC Randonneurs
7068 Mawhinney Close
Burnaby, BC  V5B 4W2

Distance: 25 km____, 50 km ____, 100 km____

Name_______________________________________________________________

Address_____________________________________________________________

City __________________________________Postal Code____________________

Phone___________________ e mail______________________________________

19 years old and over: members $15, non-members: $18
Under 19 years old: $10 ---> (You will need to have the waiver [below] signed by your parent or guardian)
(Note: It's members $20, non-members $25 on ride day)

Amount enclosed: $___________
(Please do not mail cash)
Cheques Only - make
cheques payable to: BC Randonneurs

 

Emergency contact for ride day (name and phone #): _________________________________________

Participants must complete and send in the event waiver:

Event Waiver [PDF]