Pre-Registration Form

You must be 18 years or older to ride in WBFK event on April 2, 2016.

Pre-registration form must be mailed by March 14, 2016.

Name_____________________________________ DOB_____________, M ____, F

____
Address_________________________________________________________________
_
City_____________________________________ State________ Zip
Code___________
Phone__________________
Email____________________________________________
I will ride (must check one): _____ 64 Mile, _____ 34 Mile, _____20 Mile,
_____10 Mile
Pre-Registration Fee: ____$45
Note: After March 14, 2016 there is no guarantee of shirt and the day of event
registration fee will be $50.

Circle Shirt Choice: Men's

Women's

Circle Shirt Size:

No Shirt
XL

Emergency Contact:
_________________________________Ph_____________________

Rider's Signature
____________________________________Date____________________
Rider must also sign attached waiver
Page 1 of 2

pre- registration form 2015 rev 1.docx

January 22, 2015

Mail signed application,

check and waiver to:
We Bike For Kids
P.O. Box 2166
Lady Lake, Fl 32158

Page 2 of 2

Contact:
Tim Simpson
Ph. 845-825-1025
wbfk16@gmail.com

pre- registration form 2015 rev 1.docx

January 22, 2015