REGISTRATION - Under Constructiom [BETA]

Enter Contact Information:

Item	Please complete all boxes
First or Intials or Nick Name:
Last Name:
Gender:
Birthdate:
Drivers License Number:
Best Email Adddress:
Mailing or P.O. Box Address:
Unit or Apartment Number:
City:
State:
ZIP:

Participant Adjustments:

Question	Y / N
Under the age of 10 years old?
Are you 70 years old?
Have you been a resident of the Roaring Fork Valley for one year?
Will you be coming here with your family?
Want to ride in all organized events? (Hill, Distance & Scenic)

Select Desired Event:

Event	Price	Count	Amount
Spin D' Indy™  (Recreation Hill Climb: 600 max)
Indy Pass Time Trial  (Hill Competition: 150 max)
Centaspin™  (100 Mile Century - Distance Ride)
Basalt Assault™  (33 or 66 Mile - Distance Rides)
Nite Cruisers™  (Family Wave = 75 max)
Nite Cruisers™  (Other Waves = 100 max)
Castle Crank™  (Scenic Ride)
Benefit Burrito Brunch
SUBTOTALS

Direct Contributions to Charities and/or Local Organizations:

Beneficiary	Donation
RxSURE® - Prescription Medication System
SPINHEAD® Foundation
Bicycle Colorado
LIVESTRONG® Challenge
National Multiple Sclerosis Society, Colorado Chapter
Independence Pass Foundation
Aspen Valley Ski & Snowboard Club (AVSC)
Aspen Junior Hockey
Glenwood Junior Hockey
Diabled American Veterans
SUBTOTALS

GRAND TOTAL

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