Pedal and Paddle Registration

Please click on this WAIVER RELEASE FORM to open it in your browser.  Then please print and complete it.  Each participant must have a completed waiver.  Bring it with you to the event.  This will save a lot of time.  Thanks for your participation!

Billing Information
* First Name:
* Last Name:
* Address:

,
* Email:
 
Registration Information
* First Name
* Last Name
* Address 1
Address 2
* City
* State
* Zip
* Email
* Phone ( ) -
* Age
Height (in inches - so we can have the correct size bike for you)
Emergency Contact Name
Emergency Contact Number ( ) -
Did you download and print the waiver form?  Yes
  No
* Which Pedal/Paddle Event?  October 2-Columbia Bottom P&P
Would You Be Interested in Future Dates?  Yes
  No
Comment
Family Member 1 Name
Family Member 1 Age
Family Member 1 Height
Family Member 2 Name
Family Member 2 Age
Family Member 2 Height
Family Member 3 Name
Family Member 3 Age
Family Member 3 Height
Family Member 4 Name
Family Member 4 Age
Family Member 4 Height
Family Member 5 Name
Family Member 5 Age
Family Member 5 Height
* Amount:
Other Amount: $
* Captcha: Please type the letters as they appear in the box below.
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Payment Information
* Card Type:

   OR   

* Card Number:
* Expiration Date:
/
(MM / YYYY)
* CVV Code:   Last 3 digits on back of card