Konocti Challenge
Rotary Club of Lakeport
Saturday October 4, 2008
One per rider       (submit additional forms for each rider - including tandem riders)
Last Name:     First Name:
Address:     Age:
City:     State:      Zip:
Phone:     E-Mail:  
Emergency Contact Name:     Number:
RIDE OPTIONS - No Refunds  
30 MILES     (TANDEM - 2X)
$40
65 MILES     (TANDEM - 2X)
$50
100 MILES   (TANDEM - 2X)
$60
19 MILE Family Fun Ride
$20
FAMILY FUN RIDE (12 and under)
$10
Free T-Shirt, water bottle and patch for first 400 registered riders.
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_
Shirt Size
S
M
L
XL
XXL
 

Lakeside BBQ Dinner Vegetarian Meal Available (for registered rider)
N/C
Lakeside BBQ Dinner Vegetarian Meal Available for non-rider
$15
$

Konocti Challenge Rider Jersey     
$75
$
Jersey Size:
S
M
L
XL
XXL

Additional Donations Greatly Appreciated      (Nonprofit ID # 94-6105065)

GRAND TOTAL      (Please total enter ride, late reg. & extra meal costs)
NOTE: $10 surcharge for day of event registration

$
No Refunds
If you have a child under 18 years old a release for consent for emergency medical treatment must be completed and submitted. Please click here to download and complete this form. Once completed you may mail or submit this form on the morning of the ride.
Helmets Required on all courses
All funds raised benefit local and International Rotary Programs
Riders are required to sign release waiver at registration on the day of the event

Just click to complete registration by choosing to go to PayPal's secure site or printing the form you will submit with your personal check!