Registration
Name *
Address *
City *
State
Zip
Age *
Name *
Emergency Contact: (name and phone):
Email
Route Selection *
Home Phone *
Work Phone *
Phone *
Please indicate shirt size: *
Pre-registration fee:
cyclists $30.00
5K runner/walker $25.00
Kid's Fun Run $15.00
Snoozin' participant $20.00
Additional $5 for late registration after April 6.
Registration *
$
Extra Tshirt(s) ($15each)
$
Total Payment *
$
By submitting this form, you agree that you have read the release form required for participation in this event
ALL RIDERS MUST WEAR A HELMET TO PARTICIPATE!!!
size
Fees/Registration/Confirmation
To register by mail, please print and complete the form, sign the waiver and return with the appropriate amount to:
Tour de MayberryMountain Valley Hospice and Palliative Care401 Technology Lane, Suite 200Mount Airy, NC 27030Pre-registration fee:
cyclists $30.00
5K runner/walker $25.00
Kid's Fun Run $15.00
Snoozin' participant $20.00
Additional $5 for late registration after April 6.
Fee includes a Tour de Mayberry t-shirt (while supplies last),
snackage, and registration packet.
Register early to get your 2012 Tour de Mayberry t-shirt!
After receiving your registration and fee we will send a confirmation of receipt.
All routes will begin and end at Mountain Valley Hospice Office.
Cyclist registration 7:00 - 7:45
Tour begins promptly at 8:00
SAG support 8:00 am - 3:00 pm
Run/walk registration 8:00 - 8:45
5K begins promptly at 9:00
5K timing ends at 9:45
5K support ends at 10:00
Kid’s Fun Run begins 9:45
at registration: bagels, fruit, coffee, juice, Gatorade and bottled water
rest stops stocked with oranges, bananas, trail mix, crackers, water and gatorade
lunch: sandwiches, chips and fruit sonkers
SAG Support available until 3:00 p.m.
ALL RIDERS MUST BE BACK BY 4:00 p.m.
Cancellations/Refunds
If we receive a written notice at least 10 days before the event date, we will refund your entire payment.
If you cancel your reservation less than 10 days before the event, you will receive 50% of your payment.
