To sign up before July 18, 2005, fill out this form, print it and send with your payment to:
Registration Coordinator c/o WOMBATS P.O. Box 757 Fairfax, CA 94978
After July 18, please register on day of event.
Make the check or money order payable to: WOMBATS
For registration confirmation by mail, send a self-addressed stamped envelope along with this form.
For confirmation by email, check here:
E-mail address:___________________________________
Name Address Area Code and Phone Number Email Address Emergency Notification
Age category Under 18 (kid) Gen-X Over 40 (don't ask)
What type of rider are you (check one) Honest to goddess beginner Fun/social Fitness Racer - or do you just race to the bathroom?
What type of maintenance do you want to learn about (check a maximum of 3): Lube and tire change Post ride maintenance Pre-ride safety check Bike sizing/fit clinic Chain repair Events will be planned in accordance with response
I have enclosed payment of $85 for members $100 for nonmembers before June 5 $110 for members on June 5 or after Registration for event includes lunch, teaching, and rides
Add a Wombats tee shirt ($15) M L XL
Add a 4-color event tee shirt ($25) M L XL
In consideration of my entry, and of my own free will, I for myself and my heirs, executors and heirdressers forever permanently waive any claims or liability, including the usual worst-case scenarios (broken nail, broken collar bone, broken neck) against Jacquie Phelan, the Women's Mountain Bike & Tea Society, and its officers, which may arise from my participation in the Teacup Tango on July 23, 2005.
I fully understand mountain biking has inherent risks, and agree to AVERT the dreaded Starvation Scenario by having a huge, healthful breakfast no more than two hours prior to the class.
Name _________________________________
Signed _________________________________
Date _______________
