Alfalfa Bill Bicycle Ride Registration Form | Tishomingo, Oklahoma | Tishomingo, Oklahoma


Name (Print)___________________________________________________________________________

Address _______________________________________________________________________________

City______________________________________________    State________ Zip__________________

T-Shirt Size:  [Circle one]         S   M    L     XL     XXL     $25 pre-registration is due by  Oct. 10.  After that registration is $30.  The ride starts at 9 a.m. in Pennington Park.          

Telephone:__________________________ E-Mail: _________________________________________

Route [Circle One]   10 mile    20 mile    30 mile    46 mile   Century Ride       

Mail Registration to:  Fran Morrell, 106 South Byrd, Tishomingo, OK  73460.  Make checks payable to the:  Tishomingo Development Team.                          

(580)371-3358  franmorrell@tishomingo.com

Disclaimer: Neither the Tishomingo Development Team nor any other individual or organization assumes any responsibility for any damages, injury or other problems which arise directly or indirectly from anyone's participation in this event.

Rider's Signature___________________________________________

If Under 18, Parent/Guardian's Signature _______________________________________

© rex morrell 2016