Peddlin in the Park Registration Form

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Select a Race(Required)

Women's Fat Tire 16+

Women's Non Fat Tire 16+

Men's Fat Tire 16+

Men's Non Fat Tire 16+

Junior Fat Tire under 16

Junior Non Fat Tire under 16

Relay: 2 Adult 1 Junior

Total

Second Adult Relay Name(Required)

First Last

Junior Relay Name(Required)

First Last

Liability Waiver - In consideration of the acceptance of the right to participate, entrants, participants and spectators by the execution of this entry form, release and discharge and wave responsibility to Green Lake Greenways and any of it's affiliates for damages or loss of my bike or injury to my person that may occur at this event.

Signature(Required)

Second Adult Relay Signature(Required)

Junior Relay Signature(Required)

Date(Required)

Payment Method(Required)

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Comments

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