Individual

Tour Series: $15.00

Discount of $5 when also joining Wisport Road Race or Time Trial Series

(Mail both forms)

Household (Each Member)

Tour Series: $12.00

Tandem (both Riders)

Tour Series: $15.00

Last Name

First Name

Gender

Age

Mailing Address

State

State

Zip

Phone

Email Address

Emergency Contact:

Emergency Contact Phone:

Each rider sign and date below. For riders under the age of 18, parent or legal guardian must sign and date.
   IMPORTANT, Parent / guardian please print your name and the name of the minor next to your signature.

By signing, below you agree to abide by the rules and decisions of Wisport and Wisport event directors.  You further understand that Wisport, its members, sponsors, officers and directors are not responsible for, nor have they made any representations about the safety of, and/or the safe conduct of any series events or activities, and you hereby relieve them of any liability therefore.

Signature

Date

Make check payable to:

Wisport Cycling Series LLC

Mail to:

7133 Valhalla Trail

Madison, WI   53719

Amount Enclosed:

 $