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)

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Emergency contact: ___________________________________________________________

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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 ________________________________________________________