2007

Highway 212 “Gut Check”

Registration

Name:___________________________ Phone:____________________

Email:___________________________ Attending Post Race BBQ: Yes No

Circle One: Male / Female Age as of 8-17-2007: _____

Category: ___ Solo ___ 2 Person Relay ___ 4 Person Relay ___ Leapfrog

Team Name (If applicable): __________________________

Team Members: 1)_______________________ 2)_______________________

3)_______________________ 4)_______________________

*Each participant must fill out a registration form*

Rider Bio: (Info to be posted on race website. Leave blank if you prefer not to be listed)

Possible info to include:

Years riding, favorite ride, reason for entering the “Gut Check”, ect…

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Enter desired ID info below: (15 characters per line. Spaces count as a character)

Line 1) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Make Checks Payable To: Josh Ellis

Line 2) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Amount Enclosed: $______________

Line 3) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Line 4) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ The CCFA Thanks You For Your Support

Line 5) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ www.ccfa.org