DIRTY DOZEN & THE SUPER SIX |
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| Pre-Registration must be postmarked
no later than January 24, 2009 to receive discounted entry fee & T-Shirt.
Mail Registration and Non-Refundable Race Fees (Check or Money Order) to
Terra Firma Promotions, LLC Please circle a CATEGORY: DIRTY DOZEN 12 HOUR RACE: $75.00 per rider pre-registration / $85.00 per rider race day registration ARE YOU RIDING A SINGLE SPEEED?__________
5 person 4 Open 4 Female 4 Masters 4 Coed 2 Male 2 Female 2 Coed Solo female Solo male sport Solo male expert SUPER SIX (6) HOUR RACE: $55.00 per rider pre-registration / $65.00 per rider race day registration 2 Open Solo Female Solo Male Team Name:______________________________________________________ Team Captain Name:_______________________________________________ Address:_________________________________________________________ City:__________________________ State:_____________ Zip:_______ Email:(Prerace Info)__________________________________ Home Phone:______________________________________________ Cell Phone:______________________________________________ Emergency Contact: __________________________________________
Ages on 12/31/2009:(1)_____ (2)_____ (3)_____ (4)______ (5)_______
T-Shirt Sizes:(S,M,L,XL,XXL)_________________________________________
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