Click file / print to print this entry form for the 2011 Fall Century,
 then exit this window.  Please use one form for each bike entry.

Name __________________________________________________

Address _______________________________________________

City/State/ZIP ________________________________________

Email _________________________________________________

Phone _________________________________________________

I'd like to volunteer! Call me: __ Email me: __

Do you want your name and hometown posted on our website
 for carpooling purposes?  Yes  No  (circle one)

Century Ride (100 miles) $60.00 = ______
Short Course (30 or 45 miles) $50.00 = ______
Tandem Entry (100 miles) $85.00 = ______
Tandem Entry (30 or 45 miles) $75.00 = ______
Ride Jersey (until 8/21/11, $85 after)    S M L XL  $75.00 = ______
Lds Jersey (until 8/21/11, $85 after)     S M L XL  $75.00 = ______
Mens T-shirts (until 8/21/11, $18 after)  S M L XL $15.00 = ______
Lds T-shirts (until 8/21/11, $18 after)   S M L XL $15.00 = ______
Late Fee (if postmarked after 8/21/11) $10.00 = ______
 Total = ______
Mail entries must be postmarked by August 31, 2011. Late registration fee of $10 applies to pre-registration postmarked after August 31, 2011. No pre-registration will be accepted after September 1, 2011. On-site registration will be available at Footloose Sports in Mammoth Lakes starting Wednesday, September 7. A $15 late fee will apply to on-site registration. A limited number of jersies and t-shirts will be available for purchase at the ride starting on September 7 while supplies last. Jersey cost at the ride will be $85 and T-shirt cost will be $18 Check or money order only - checks payable to "High Sierra Fall Century" Mail this form along with your payment to: High Sierra Fall Century 1674 Hwy 395 Ste 207 Minden, NV 89423 Your registration will be confirmed via email if provided Credit Card payment is accepted online at www.FallCentury.org - click on "Registration" No fax entries accepted

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