2021 RAGBRAI
Bike Burlington Support and Transportation Form
Email address *
Note
Rider must be a Bike Burlington member and registered with RAGBRAI in order to camp with Bike Burlington. Membership application and dues can be submitted online as well. That form can be fill out this address. https://docs.google.com/forms/d/e/1FAIpQLSfurd-QGNttNW6_kMklKbw0iekuz3Emos4hCEOYaka-Ub_HtA/viewform
2021 Bike Burlington Dues (If paying by check include in envelope) *
Choose t-shirt size *
How many RAGBRAI's have you been on? *
Type of Bike: *
If riding a Tandem, please list other Rider:
What type of support? "RAGBRAI may not allow daily riders for 2021" *
(Daily Riders only) indicate number of day(s)
(Daily Riders Only) Select days "Only if RAGBRAI Allows"
Paying online or sending a check (payment must be received by March 31st for discount) *
First Name *
Last Name *
Street Address *
City *
State *
zip *
Phone *
Will you be 21 or older the week of RAGBRAI? *
Emergency Contact *
Emergency Contact Phone *
Emergency Contact Relationship *
COVENANT NOT TO SUE:
The undersigned, for and in consideration of the privilege of participating in events and activities organized and sponsored by Bike Burlington, Inc., hereby covenants and agrees not to sue Bike Burlington, Inc., it’s officers or agents for damages which may be incurred by the undersigned arising out of the undersigned’s participation in such activities or events and caused by the negligence of Bike Burlington, Inc., it’s officers and agents
Rider (or parent or guardian signing for child under 18) Type full name *
Check Box to confirm Signature *
Required
If Rider is under 18
Please list the accompanying riders information. (rider must be traveling with Bike Burlington) If this section is not applicable please put NA for the next two questions.
Accompanying riders Name *
Accompanying riders Phone *
Please include additional comments here. Thank you!
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