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Current Schedule (SF Bay and Anchorage), Rating System, and Riding Tips
Current Schedule (SF Bay and Anchorage), Rating System, and Riding Tips
Skills Clinics, Teacup Tango, Mt Tam Camp
Skills Clinics, Teacup Tango, Mt Tam Camp
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Jersey, Tee Shirts, Tea Towel, Patches, Sticker
teacup tango : sign up Mission, History, Founder, and Articles by WOMBAT Members Sponsor and Related Sites Membership, News, Chapters, etc.

2005 Teacup Tango
Signup Form

To sign up before July 18, 2005, fill out this form, print it and send with your payment to:

Registration Coordinator
c/o WOMBATS
P.O. Box 757
Fairfax, CA 94978

After July 18, please register on day of event.

Make the check or money order payable to: WOMBATS

For registration confirmation by mail, send a self-addressed stamped envelope along with this form.

For confirmation by email, check here:

E-mail address:___________________________________

Name

Address

Area Code and Phone Number

Email Address

Emergency Notification

Age category
Under 18 (kid)    Gen-X     Over 40 (don't ask)

What type of rider are you (check one)
Honest to goddess beginner
Fun/social
Fitness
Racer - or do you just race to the bathroom?

What type of maintenance do you want to learn about (check a maximum of 3):
Lube and tire change
Post ride maintenance
Pre-ride safety check
Bike sizing/fit clinic
Chain repair
Events will be planned in accordance with response

I have enclosed payment of
$85 for members
$100 for nonmembers before June 5
$110 for members on June 5 or after
Registration for event includes lunch, teaching, and rides

Add a Wombats tee shirt ($15)
M
L
XL

Add a 4-color event tee shirt ($25)
M
L
XL


Waiver and Release of Liability

Please read and sign below:

In consideration of my entry, and of my own free will, I for myself and my heirs, executors and heirdressers forever permanently waive any claims or liability, including the usual worst-case scenarios (broken nail, broken collar bone, broken neck) against Jacquie Phelan, the Women's Mountain Bike & Tea Society, and its officers, which may arise from my participation in the Teacup Tango on July 23, 2005.

I fully understand mountain biking has inherent risks, and agree to AVERT the dreaded Starvation Scenario by having a huge, healthful breakfast no more than two hours prior to the class.


          


Name _________________________________

Signed _________________________________

Date _______________



PO Box 757 Fairfax, CA 94978 415 459-0980 jacquie@batnet.com wombats.org