FLCC> Tour de Shunk part 2: registration

[William Lodico]

The Ninth Annual
Tour De Shunk Century Ride
Pre-Registration Form (before Sept 7)
NAME (please print): ___________________________________
ADDRESS: ___________________________________________



PHONE: _____________________________________________
AGE: ________________________________________________
E-MAIL: _____________________________________________
T-SHIRT SIZE: Circle One      S   M   L   XL   XXL
WAIVER: All persons are required to wear a helmet throughout the ride  
and sign a waiver.
SIGNATURE: _________________________________________

SIGNATURE OF PARENT: ______________________________
(If under 18)
Make checks ($25 per rider) payable to “Endless Mountains Cycling  
Club” and send along with this completed form to:

Endless Mts. Cycling Club
c/o Greg White
RR 2, Box 301 A-2
Mehoopany, PA  18629
Ph# (570) 833-4261