Click file / print to print this entry form for the 2010 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) $50.00 = ______
Short Course (30 or 45 miles) $40.00 = ______
Tandem Entry (100 miles) $75.00 = ______
Tandem Entry (30 or 45 miles) $60.00 = ______
Ride Jersey (until 8/21/10, $80 after) S M L XL $70.00 = ______
Sleeveless Vest (until 8/21/10, $80 after) S M L XL $70.00 = ______
Lds Sleeveless (until 8/21/10, $80 after) S M L XL $70.00 = ______
T-shirts (until 8/21/10, $15 after)    S M L XL$12.00 = ______
Late Fee (if postmarked after 8/21/10) $15.00 = ______
 Total = ______
Mail entries must be postmarked by August 30, 2010. Late registration fee of $15 applies to pre-registration postmarked after August 21, 2010. No pre-registration will be accepted after September 1, 2010. On-site registration will be available at Footloose Sports in Mammoth Lakes starting Wednesday, September 8. 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 8 while supplies last. Jersey cost at the ride will be $80 and T-shirt cost will be $15 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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