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)
Make cheques payable to: BC Randonneurs or pay by credit card:

Card #: __________________________________ Expiry Date:_____________

Name on Card: ___________________________________________________

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

Participants must complete and send in the event waiver:

Event Waiver [PDF]