2022 Dying Leaf Ride Registration

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Name *

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Email Address *

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Cell Number: *

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Attendance *

Choose

Yes - No Passenger

Yes - With Passenger

Passenger's Name

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Ride Roommate (if applicable)

Your answer

Emergency Contact Name *

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Emergency Contact Telephone Number: *

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Bike for this Ride: *

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Fuel Range: *

Choose

125 Miles

150 Miles

175 Miles

200 Miles

225+ Miles

Would you like a copy of the Garmin Routes?

Yes

Please add any comment(s) here:

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