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Pottawattamie Peddlers 2018 Club Registration Form
We support only registered RAGBRAI riders. Lost & Found Adventures, LLC, PO Box 366, Neola Ia 51559. We require your email address so that we can send you updates throughout the year. We will not sell or give your email address to any other parties.

Club fee $15/family (Family: same address & children 18 & under)

Email address *
Names and birthdates of family members for this family for membership (remember to include yourself) *
Your answer
Address (Street 1) *
Your answer
City *
Your answer
State (2 Letter Abbreviation Only) *
Your answer
Zip Code *
Your answer
Daytime Phone
Your answer
Evening Phone
Your answer
Applicant under 18 must be accompanied by a responsible adult, All applicants must be signed and in digitally signing this application / liability release agrees to the following, I waive and release Pottawattamie Pedalers, all members, all employees, all officers and their family’s and anyone else connected to the group from all liability for personal injury, property damages, theft or any loss that takes place during any event that the group joins or sponsors. This waiver shall also apply to any minor children or to any claim I may have on their behalf, *
By typing your name into the box below you are electronically signing your name.
Your answer
Date of registration submission
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DD
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YYYY
Parent electronic signature (if rider is under 19 years old)
Your answer
A copy of your responses will be emailed to the address you provided.
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