CU Across the Prairie & Gran Fondo 2017 Registration

After completing this form (*'d fields required), clicking on the Submit button below directs you to Paypal for payment (be prepared for a 5 to 15 second delay).    Once at Paypal, to pay by credit card, click on the link near the bottom right that says either "Don't have a Paypal account" or "Pay with a debit or credit card".    Report any difficulties to webmaster@prairiecycleclub.org

Name *
Address *
E-mail *
Phone *
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To join PCC through 2018 or to renew a PCC membership through 2018, complete the following four items--otherwise skip to the WAIVER AND RELEASE below:
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Gender
Birthdate:
 /  / 
Is this a new or renewal membership?
Available Membership Types:
       $17 Individual
       $22 Household (multiple persons living at same residence)
       $12 Student OR dues paying individual belonging to CCB, Bike Project or Wild Card Cycling
Membership type
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WAIVER AND RELEASE *
  • In registering for C-U Across the Prairie, I hereby release and waive all claims against the Prairie Cycle Club (PCC), its officers and members, successors and assignees, for any damages resulting in injury either to myself, to others I register, and to my/our equipment during the above-named event. (Individuals under the age of 18 must be registered by a parent or legal guardian to ride with C-U Across the Prairie.)
  • If also joining the Prairie Cycle Club, I/we acknowledge that bicycling in and of itself can be dangerous, and hereby release and waive all claims against the Prairie Cycle Club (PCC), PCC members, PCC officers and directors, and successors and assignees, for damages resulting in injury either to myself, members of my household, or to my or my household's equipment during any and all PCC-sponsored events.
  • Helmets are strongly recommended for all PCC-sponsored bicycling activities and for all bicyclists.

... Check this box to register for the 7 mile Family Ride .......
Family Ride (7 Miles) -- post-ride lunch not included

... Long Rides .......
Provide the name, age and appropriate registration fee for up to each of three riders you are registering, including your self (if you are riding), from your household for any of the longer rides.
** Do not provide these names if only registering for the 7 mile Family Ride.
Registration fees are
    25 & 45 mi rides: Individual: $30 ; Family $45
    65 & 100 mi rides: Individual $40; Family $65
Children under 12, accompanied by an adult, ride the longer rides for free.


----- Rider (1) individual or first long ride household member ---------------
Name (1)
Age (1)
Regis. Fee (1)
----- Second rider for household registration ---------------
Name (2)
Age (2)
----- Third Rider for household registration (if applicable) ---------------
Name (3)
Age (3)
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If the total below shows $0, before clicking "Submit" you must you specify your registration fee(s), by either
(i) clicking the family ride ride check box and/or
(ii) making a selection from the "Regis. Fee (1)" pull down list!
Total: