Make checks payable to Citizens of Georgia Power
Mail to: Roopville Ramble, c/o eNetFirst, Inc., 1002 Maple Street, Carrollton, Ga 30117

Rider's Name___________________________ Address_________________________________
City____________________________________ State________ Zip______________ Sex____
Rider's Cellphone__________________________ Home Phone__________________________
Work Phone___________________________ Email Address____________________________
Emergency Contact_____________________ @ Emergency Phone # ____________________

Rider's Birthdate_____________     Circle one:   15mi  37mi   50mi    67mi   104mi

TANDEMS ONLY   Stoker's Name ____________________ Birthdate ______________ Sex____

2017 RR Registration and Options Workbox
ITEM	DETAILS	QTY/PRICE	SUBTOTALS
Rider Fee	$40 for Singles   $80 for Tandems	Qty One(1)	$
Junior Fee	$30    12 and Under	Qty One(1)	$
- - ->	Postmark by 4/21 subtract $10	or by 5/10 subtract $5	$
Additional Donation	Gratefully accepted!	- - ->	$
Rider T-Shirt	Circle Size    S    M    L    XL    XXL	Qty One(1)	Included
Stoker T-Shirt	Circle Size    S    M    L    XL    XXL	Qty One(1)	Included
T-shirts guaranteed to pre-registered riders only.
Extra Event SS T's	Size ____ Size____ Size ____ Size____	#____@ $12.50 ea	$
GRAND TOTAL INCLUDED (checks and money orders only) Payable to Citizens of Georgia Power			$

By affixing my signature I attest that I have read and agree to the Roopville Ramble Liability Waiver
and I further agree to sign waivers as necessary at registration, including a copy of the RR Liability Waiver.

Signature____________________    Guardian sign here for under 18 years____________________

TANDEM ONLY
Stoker Signature____________________   Guardian sign here for under 18 years____________________

Ride Starts at 8:00 am May 20, 2017 - Ride will be held rain or shine - NO REFUNDS!
Sag stops and mechanical assistance provided on all routes.
Courses will be marked and maps provided.