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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Keith's Web-Stuff.org