Bicycle for Life

Carolina Flèche - 2014 Individual Pre-Registration is closed

RUSA - High Point, NC USA - Region

Please use the below form to pre-register an Individual Team member to participate in Bicycle for Life Flèche which is scheduled by the RUSA High Point NC USA Region April 18-21, 2014.

If you have any trouble completing the form, please let us know what the specific issue is with the form. The information requested from you on this form is intended to be used to fill out your official control card and should only be used as needed by official BFL staff pertaining to the Flèche that you participate in with BFL. The info on this form is sent via an email system!

If you do not want to send this info via email, please print this page and mail it to Bicycle for Life • 1935 Barringer Rd • Salisbury NC 28147. If you mail it in, please use our standard contact form to let us know you are planning to ride.

If you do not pre-register, you will not be able to start or participate in the Flèche. Event registration will close in March.

Thank you for pre-registering for the Flèche

Bicycle for LIfe
2014 Carolina Fleche
Team member Pre-Registration Form

* Required fields

Fleche Team
*
You will be on:

Age of Bicyclist: *
First Name: *
Last Name: *
Street:*
City:*
State:*
Zip:*
(5 digits only)
RUSA #:*
Note: Must be a current Active RUSA Member for your official finish to count towards some awards (check with RUSA for details)
(Member lookup)
enter 0000
if you are new to RUSA & membership form has been mailed in recently
Club Name:*

Club ACP #:*
(lookup your Club ACP #)


ACP code
numbers only
Email Address: *

 Verifiy Email Address:*

Phone:*
0123456789
( 10 digits only )
Emergency
Contact: *
Emergency
Phone Number:*
0123456789
( 10 digits only )
Comments:
Registration Donation Pledge:

Cash or Good check accepted for event registration


Please bring donation pledge with you to event finish or mail it in with your signed waivers!

Credit Cards are only accepted online through PayPal via our Donate Page
Please add a note along with your donation indicating what it is for!
Waiver:
*
Checking this box electronically comfirms that you agree to and with the waiver/release and other statements in this form in the box to the right!

Please note that you will be required to sign a wavier form prior to starting the ride.

Download and print

Mail-in Release/Waiver

You Must agree to this waiver to process this form!
After you submit this form
you may print the info submitted using your browser.
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