Mail Registration to:
River City Cycling Club
P O Box 295
Elizabeth City, NC. 27907-0295
Make checks payable to RCCC: $35.00 per adult registrant, $20.00 per child (no t-shirt)
No confirmation will be sent.
For additional info call Ed 252-267-3312 or Cycle Gallery 252-338-1559 ( 10:00 am to 6:00 pm)
Name: ______________________________________________________________________
Address: ____________________________________________________________________
City: _______________________________________________________________________
State: ______________________________________ Zip: ___________________________
Phone number: _______________________________________________________________
Emergency contact: ___________________________________________________________
Emergency contact phone: _____________________________________________________
I plan to ride the: Third Century (31) - Metric Century (61)
- English Century(100)
T-Shirt Size: S M L XL XXL No T-shirt (MUST REC'V BY APRIL 5th for t-shirt)
If under 18, have parent sign for permission. Riders under 16 must be accompanied by an adult.
River City Cycling Club is affiliated with the League of American Bicyclist and a waiver must be signed prior to ride. Please sign below agreeing to do so.
Signature/Date ____________________________________________________________
Guardian if required ________________________________________________________