C ³= 100  June 9, 2012

Name___________________________________________________________

 Address__________________________________________________________

 City_______________________ State_____________ Zip ___________

 Home Phone____________________ Work Phone_____________________

 Email address_________________________________________________________

 Age_________________ Male_____ Female____

T-shirt size  ____small  ____med  ____large  ____x-large 

(First 34 registered receive free t-shirt)

 

 Pre-registration $20  per rider      {$25 the day of the event}

 Make checks payable to:           Curt’s Cyclery

                                                      182 Bath Pike

                                                      Nazareth, Pa 18064

Join us as we raise money for a most-worthy cause….

 

Visit our website: curtscyclery.com  for more info or call 610-759-5134