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RUSA Brevets Pre-Registration

High Point-NC-USA Region

Please use the below form to pre-register for the all Bicycle for Life Brevets that are scheduled by the High Point NC USA Region.
If you have any trouble completing the form, please let us know what the specific issue is with the form.
The information requested from you on this form is intended to be used to fill out your official brevet card
and should only be used as needed by official BFL staff pertaining to the brevets that you participate in with BFL.
The info on this form is sent via an email system! If you do not want to send this info via email, please print this page
and mail it to Bicycle for Life Brevets • 1939 Barringer Rd • Salisbury NC 28147.
If you mail it in, please use our standard contact form to let us know you are planning to ride.
You should also be able to register at the event prior to the start. It is strongly suggested that you pre-register.
If you do not pre-register, your start may delayed or you may not be able to start with the other riders.
Day of event registration will close at the official event start time for Brevets.

Thank you for pre-registering for the events you plan to participate in!

Bicycle for LIfe
RUSA Brevets Lexington, NC USA
Pre-Registration Form

* Required fields

First Name: *
Last Name: *
Street:*
City:*
State:*
Zip:*
(5 digits only)
RUSA #:*
Must be an Active Member to get credit for finish
(Member lookup)
(use none
if not a RUSA member)
(use applied for
if you are a new member and have not received your number for 2008)
Club Name
Club ACP #:*
(lookup your
Club ACP #)
Email Address: *

 Verifiy Email Address:*

Phone:*
10 digets only
area code then number
Send info:
  Yes
 No
Contact me:
  E-Mail
 Phone
Emergency
Contact: *
Emergency
Phone Number:*
Age of Bicyclist: *
If under 18 years old
Parent or Guardian
Please mark the Brevets
you plan
to ride: *

Please note that Pre-Reg is closed for Labor Day Weekend!

If you want to ride, please come early and also call to let us know you are riding! 704.637.6289

We will have a few extra cards and Quesheets.
October
Saturday

Oct 9-
600 K
7:30 am
Start		 40 hour
time limit
Oct 9
400 K
7:30 am
Start		 27 hour
time limit

Oct 9
300 K
7:30 am
Start		 20 hour
time limit
Oct 9
200 K
7:30 am
Start		 13.5 hour
time limit
Sunday

Oct 10
300 K
7:30 am
Start		 20 hour
time limit
Oct 10
200 K
7:30 am
Start		 13.5 hour
time limit

Donation Pledge:

Please bring your pledge to event registration in the form of Cash or a Good_check which will be accepted at event registration for your donation

Credit Cards are only accepted online through
PayPal via our
Donate Page
Please add a note along with your donation!

Please keep in mind that if you use your credit card, we will be charged a fee for that service, so please consider adding 5% to your total to cover the expenses for CC use.


Suggested Donation Pledge each:
200k is $20
300k is $30
400k is $40
600k is $60
1000k is $100
2x300k is $50
2x200k is $30

Donations help cover the cost/expenses related to planning, organizing and running brevets thru Bicycle for Life

Please order your medals directly from www.RUSA.org

Medal fees: Look here
Only Current RUSA Members can order medals!
Comments:
Waiver: *

Checking this box electronically comfirms that you agree to and with the waiver/release and other statements in this form in the box to the right!

Please note that you will be required to sign a wavier form prior to starting each brevet ride at the official brevet registration for each event.

You Must agree to this waiver to process this form!
After you submit this form
you may print the info submitted using your browser.
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