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Vegan Randonneur / RUSA Permanent Registration - RUSA Membership REQUIRED
* NO Ride Fee - All Permanents *
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First Name
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Last Name
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Telephone
*
Your answer
E-mail
*
Your answer
RUSA Number
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Your answer
Any health concerns
*
Your answer
Emergency Contact - Name
*
Your answer
Emergency Contact - Telephone
*
Your answer
Permanent - Route Number
*
Your answer
Permanent - Route Name and Starting Location / Ride Direction
*
(Example - "Mt. Washington Loop - Blue River, OR - Clockwise")
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Permanent - Ride Date and Start Time
*
(Ex. "7/16/16 @ 0900"
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Are you a current RUSA member?
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