Registrant Contact Information:

Last Name: _______________________________  First Name:________________________

Address: ___________________________________________________________________

City:______________________   State/Province:_________________  Zip: ___________

 Age: _______   Email: ________________________   

Home Phone: __(_____)_________________________     Work Phone:_(____)_____________

If you will not be 18 years old by June 14th please indicate the parent or guardian riding with you:   

Name: _____________________________________________ Relationship: ____________________________


Experience:

Have you ridden in bike treks before?  If so which ones?
_____________________________________________________________________________________________
_____________________________________________________________________________________________

The Yakima Ridges  Bike Ride welcomes bicyclists of varying strengths and experiences.  We want to make sure we have 
adequate support personnel and provisions.

Rate Your Bicycling Experience: q Beginner     q Fair     q Intermediate     q Advanced     q Expert 

Desired Route Distance: q 25 Miles q 45 Miles q 100 Miles 

How did you hear about the Yakima Ridges Bicycle Ride?
_____________________________________________________________________________________________

Do you have any Allergies or Medical Conditions, or if you have any special needs: _____________________________________________________________________________________________
_____________________________________________________________________________________________

Registration Fee:

$25 registration fee (Make checks payable to Yakima RidgesBicycle Ride)

Yakima Ridges Bicycle Ride
10419 Summitview Ave
Yakima, WA 98908

Sorry, no refunds on registration fee!

I agree to the waiver and liability release on the back of this form.


__________________________________________________________________
(Signature of Participant)                                                     (Date) 
(Both Parent and Minor must sign if participant is under 18)
		IN CASE OF EMERGENCY CONTACT:
Name____________________________ Relationship____________________
Daytime Phone (__)________ Evening Phone (_____)___________________