Outspokln Outspokin Name to Come Words Into Deeds Bucket List Street Legal Team Sage! Guardian Gears Taitem High Gear Geazers Bring The Ruckus Ithaca High School Blue Wave Tae Kwon Do Rider Registration 9/9/2017 About you First Name Last Name Email Date of Birth * You cannot register online because you will be under 14 years old on the day of the ride. Please email email@example.com if you have any questions. Gender MFT Existing Medical Conditions? YesNo List of Conditions Contact Info Phone Number Street Apt / Suite City State New YorkAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Accompanying Adult Rider Full Name Date of Birth Email Phone Number Emergency Contact * Your emergency contact cannot be another rider. Full Name Relationship Phone Number About the Event Miles you will ride 14254290102Indoor Are you in a team? YesNo Team Name Are you the team captain? YesNo Accept T-Shirt and gifts? YesNo T-Shirt Size Women's SmallWomen's MediumWomen's LargeWomen's X-LargeMen's SmallMen's MediumMen's LargeMen's X-LargeMen's XX-Large Are you a first time rider in the Ride? YesNo How many times have you ridden prior? Will you be attending 6pm dinner at Stewart Park? YesNo * You and one guest are included in your registration fee. Additional guests are $8.00 each (pay at dinner). Total number of dinner guests including yourself Other How did you hear about the ride? Training Notify me of about training rides. ARFL Sign I would like to display an ARFL sign for my yard. Sponsorships I would like to learn more about Sponsorship Opportunities. Other Events I would like to receive information about other STAP events. Registration Fee & Fundraising Fundraising In addition to the registration fee, I understand there is a minimum $300 fundraising requirement. In addition to the registration fee, I understand there is a minimum $100 fundraising requirement. 100 In addition to the registration fee, I understand there is a minimum $100 fundraising requirement. 100 Registration Fee $ 25 25 25 Discount Code YesNo Waiver I have read and agreed to the rider waiver. You had errors on your form. Please fix them and re-submit. A confirmation e-mail will be sent to you after you have paid the registration fee.