OBM 1000k Brevet for 2016
Registration, sign-up for the Oregon Blue Mountains 1000k
First Name *
Your answer
Last Name *
Your last name
Your answer
RUSA Membership Number *
RUSA Rider ID number provided by RUSA. If you don't have an RUSA number, use the number 15000.
Your answer
Ride Phone *
Your cell phone you can be reached at during the ride (or "None").
Your answer
Email Address *
An email address where you can be contacted.
Your answer
Emergency Contact Name *
Name of emergency contact
Your answer
Emergency Contact Phone *
Phone number of emergency contact
Your answer
Route Sheet *
Riders often customize, format and print their own route sheets. Would you like a 5x7 foldable route sheet provided by the organizer?
City *
City of residence
Your answer
State or Province *
State or Province of residence
Your answer
Mailing Address 1 *
Mailing address to send verified brevet card
Your answer
Mailing Address 2
Second line mailing address if needed
Your answer
Postal Code Zipcode *
Postal or Zipcode
Your answer
Country *
Your answer
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