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ANNUAL CONNECTION TOUR REGISTRATION FORM
Please fill out this form in its entirety.

If you have any questions contact me using the email address below.

We look forward to seeing you in Paso!
 
Fred Roth
fredr@cyclingconnection.org

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CYCLING CONNECTION MEMBERSHIP
For insurance purposes you must be a current member of Cycling Connection of Rancho Cucamonga. If you are not please visit the following page (opens in a new tab/window) to complete your online membership

http://cyclingconnection.org/Membership.html

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Current Cycling Connection Member?
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No
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add "Other"
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YOUR PERSONAL INFORMATION
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First Name
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Last Name
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Mailing Address and Zip Code
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Contact Phone Number
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Preferably a Cell Phone
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Emergency Contact Phone
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Preferably a Cell Phone
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Emergency Contact Name and Relationship
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In the event of an Emergency please list any information you would like the responders to know (health conditions, allergies, medications, etc.)
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Medical Provider Name
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Do NOT Provide Medical ID
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Medical Provider Phone
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ANNUAL CONNECTION TOUR OPTIONS
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Select your accommodations
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Tent Camping
RV Camping
Off Site Accomodations
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Car Pool / Pick up Options
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Click here if you are interested in car-pooling to or from your start
Click here if you are using AMTRAK and would like to be picked up in San Luis Obispo
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add "Other"
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Special Food needs?
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List any special food needs you have
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T-Shirt Size
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ANNUAL CONNECTION TOUR FEES
Campers (Including RV on site) $170*
Off-site accommodations $110*
(an event T Shirt is included in the registration fees)

If you are paying by check please make payable to Cycling Connection and send to :
Fred Roth
6276 Mayberry Ave,
Rancho Cucamonga, CA 91737

*a small fee will be added for online payment
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CYCLING CONNECTION MEMBERSHIP
Current Cycling Connection Member?
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YOUR PERSONAL INFORMATION
First Name
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Last Name
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Mailing Address and Zip Code
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Contact Phone Number
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Emergency Contact Phone
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Emergency Contact Name and Relationship
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Medical Provider Name
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Medical Provider Phone
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ANNUAL CONNECTION TOUR OPTIONS
Select your accommodations
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Car Pool / Pick up Options
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Special Food needs?
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T-Shirt Size
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ANNUAL CONNECTION TOUR FEES
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