•ONLINE entry form

  •Printable PDF document of this form

2012 SOLVANG CENTURY, METRIC & HALF CENTURY
PLEASE PRINT LEGIBLY!

Last Name:_________________________________________________

First Name: _________________________ Initial: _________________

Birthdate:   Month: ___________ Day: ___________Year: ____________

Address: __________________________________________________

City: __________________________ State: ______ Zip: ____________

Tel. (home): ________________________________________________

E-mail Address: _____________________________________________

Tel. (work): __________________________________________________

(Please check)
Single Rider ($75.00) _____ Tandem Team ($130.00) $__________

Name of Tandem Partner: ______________________________

(Please check)
Route: 50 miles _____ Metric Century_____100 miles _____

Raffle Tickets
($1.00 EACH OR 6 FOR $5) Qty.: _____ Amount: $__________

BBQ LUNCH TICKETS
$18/PERSON X People: _____ Amount: $__________

A NIGHT WITH CHRIS CARMICHAEL DINNER
$30/PERSON X People: _____ Amount: $__________

Total from Souvenir Order Form:........$__________

GRAND TOTAL: .........................$__________

Please Indicate:

First time Solvang Rider: _____
Prior Solvang Rider: _____

SCOR
P.O. BOX 9065
Brea, CA 92822
(562) 690 9693 FAX (562) 690-0614
E mail: bikeride@roadrunner.com
www.bikescor.com

A confirmation card with your assigned bib number will be mailed to all registered riders.Please bring this card with you to the pre-registration area.

RIDE RAIN OR SHINE. NO REFUNDS.
FOR INFORMATION OR TO VOLUNTEER, CALL (562) 690-9693

Entry Form Completed: _____
Souvenir Order Completed: _____
Check Route: _____
Check or Money Order: _____
Postmarked by 2/23/2012: _____

Mail completed entry form and completed souvenir form with check or M.O. before 2/23/2012 to:

SCOR
P.O. Box 9065
Brea, Calif. 92822

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