Print out this form and mail with remittance Full price for the event is: $385.00 for 2,  $295.00 for 3 and $250.00 for 4 to a room Use this form for yourself or for a group

Riders per Room rate times (see rate above) @  50%=$________________Amount enclosed  Bal. due 5/10/04

Riders per Room rate times (see rate above)@ 100%=$________________Amount enclosed  Balance in full

Your Name: ____________________________________________________________

Address:_______________________________________________________________

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Club affiliation, if any____________________________________________________

State _________________________________Zip:_____________________________

Your E-mail:_______________________________________________________

Telephone:________________________________________________________
 

Rider  1: _____________________________________Rider  2 : ________________________________________

Rider  3: _____________________________________Rider  4: _________________________________________

Please tell us if you are riding alone or with a group. If you have a room preference, please specify. We cannot guarantee non-smoking, but we will do our best to accommodate.

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