On-Line Registration | Florida Bicycle Safari

2010 On-Line Registration
Payment is via Credit Card Only (Google Checkout)

Please fill out the form below. You will receive an e-mail with final confirmation.

First Name
Last Name
Check here if you DO NOT want your name / city / state listed on our website.
Address
City
State
Zip
Phone #
E-Mail
Your email will be used to relay event information. Check here if you wish to opt out of receiving email for non-event purposes.
Emergency Contact
Emergency Phone
T-Shirt Size (available only if registered prior to April 1st)	S M L XL XXL
Age (if under 18 or over 80)

	3-Day Safari
Adult	$150.00 per person
Florida Freewheeler	$125.00 per person
Child (under 17)	$125.00 per person
Non-riding participant	$95.00 per person

	6-Day Safari
Adult	$350.00 per person
Child (under 17)	$325.00 per person
Non-riding participant	$200.00 per person

How did you hear about us?	Florida Freewheeler Website Magazine (indicate below) Past Safari Other Events (indicate below)
Comments

I understand that Florida Freewheelers, Inc. is not an insurer of my personal safety or liability during the Florida Bicycle Safari or any associated activities. I hereby release and forever discharge and hold harmless Florida Freewheelers, Inc., its members, agents, servants, representatives, successors, sponsors, volunteers, and assignees from all liability ( personal and property) arising out of or connected in any way with my participation in this event (or my minor child’s participation in this event). I also agree to fully comply with all applicable laws and traffic regulations; to conduct my activities in a safe and prudent manner, and to wear an approved bicycle helmet and not use headphones while riding.
	By checking this box you have indicated you have read the Release Form. This will act as your signature.

Verify information is correct before hitting submit. !!! DO NOT HIT SUBMIT twice or click REFRESH !!! or you will create duplicate entries.


* Call Ride Director for reservations and/or availability.