OBM Permanent Registration
Note the required fields! Press the submit button at the bottom of the form when you are finished.
Last Name *
(required)
Your answer
First Name *
(required)
Your answer
Address 1 *
(required)
Your answer
Address 2
(required)
Your answer
City *
(required)
Your answer
State or Province *
Use the two charactor code (required)
Zipcode *
(required)
Your answer
Telephone *
(required)
Your answer
E-mail *
(required)
Your answer
RUSA# *
You have to be an RUSA member. This is your membership number. (required)
Your answer
Health Concerns
Your answer
Emergency Contract *
(required)
Your answer
Emergency Phone *
(required)
Your answer
First Permanent Route (required)
You can sign up for as many as 5 routes.
RUSA Route Number 1
You can leave this empty, You can leave this blank, I'll look up the route number.
Your answer
Route Name 1 *
Route Name (first route) (required)
Ride Date 1 *
Ride Date (first route required)
MM
/
DD
/
YYYY
RIde Start Time 1 *
Ride Start Time (first route) (required)
Time
:
Fee 1
Fee (first route) You can leave this blank, the fees will be calculated.
Your answer
Second Route Request
RUSA Route Number 2
RUSA Route Number (second route) You can leave this blank, I'll look up the route number.
Your answer
Route Name 2
Route Name (second route)
Ride Date 2
Ride Date (second route)
MM
/
DD
/
YYYY
RIde Start Time 2
Ride Start Time (second route)
Time
:
Fee 2
Fee (second route) You can leave this blank, the fees will be calculated.
Your answer
Third Route Request
RUSA Route Number 3
RUSA Route Number (third route) You can leave this blank, I'll look up the route number.
Your answer
Route Name 3
Route Name (third route)
Ride Date 3
Ride Date (third route)
MM
/
DD
/
YYYY
RIde Start Time 3
Ride Start Time (third route)
Time
:
Fee 3
Fee (third route) You can leave this blank, the fees will be calculated.
Your answer
Fourth Route Request
RUSA Route Number 4
RUSA Route Number (fourth route) You can leave this blank, I'll look up the route number.
Your answer
Route Name 4
Route Name (fourth route)
Ride Date 4
Ride Date (fourth route)
MM
/
DD
/
YYYY
RIde Start Time 4
Ride Start Time (fourth route)
Time
:
Fee 4
Fee (fourth route) You can leave this blank, the fees will be calculated.
Your answer
Fifth Route Request
RUSA Route Number 5
RUSA Route Number (fifth route) You can leave this blank, I'll look up the route number.
Your answer
Route Name 5
Route Name (fifth route)
Ride Date 5
Ride Date (fifth route)
MM
/
DD
/
YYYY
RIde Start Time 5
Ride Start Time (fifth route)
Time
:
Fee 5
Fee (fifth route) You can leave this blank, the fees will be calculated.
Your answer
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