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Cornell Triathlon Team

Words Into Deeds

Mark Rides On

Desert Dawgs

Johnson College of Business Peddlers

Blazing Pedals

Street Legal

Blue Wave Tae Kwon Do

Sheldrake Point Wineaux

Ursa Space Systems

Team Sage

Heroes of Canton

Taitem

Mad Scientists

Team Ithaca Beer

First Baptist of Ithaca

South Hill Express

Team GrammaTech

Outdoorbrendans

WRR

Joyful Fitness

The Gorski's

Team Statler

The Moreland Family

Gen Babyboom-X-ZBoomlets

mds arthouse productions

Team Hirschl

CCPA Binghamton University

Team Talbo\/Watertown Audiology and Balance Center

The Guthrie Clinic

42 Mile

Cats of Short Street

Ithaca College Crew

Boomer XYZ

Team CORNING

Faster than the Speed of AIRS

Ithaca High School Cycling Club and Friends

Team LaBella

High Gear Gezers

Cullings Family

Team Fairchild

TWMLA

Ithaca Beer

Chaffee's Champions

Southern Hill Express

Molina Healthcare of WNY

Team Tortoise

Team 545

TEAMBAPTIST

Hachi Ju Ni

Strupp-Levitsky

545

Glitter City Rollers

Rider Registration

9/7/2019

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 crotella@stapinc.org if you have any questions.
Gender MFT
Existing Medical Conditions? YesNo
List of Conditions
Contact Info
Phone Number
Street
Apt / Suite
City
State
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 1425426990102Indoor
Are you in a team? YesNo
Team Name
Are you the team captain? YesNo
Accept T-Shirt and gifts? YesNo
T-Shirt Size
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 $ 45 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.

Registration Fee

We use PayPal to accept payments. You will receive a confirmation email once the PayPal payment is confirmed.