Tour of Chautauqua Registration 2017 - Aug. 12, 2017
Name of rider
Address
Age and Date of birth
Registration Form :
Advance registration, postmarked or submitted on-line (we must receive your remittance by the date listed to be considered registered) on or before July 26, 2017 is $25.00 and riders will receive a TOUR OF CHAUTUAQUA T-shirt.
Registrations after July 26, is $28.00 and late registrants will receive a TOUR OF CHAUTAUQUA water bottle.

Call 716.326.4243 for more information.
Sponsored by the Westfield Recreation Department
After submitting this form you must send your remittance to :
Westfield Recreation Dept.
23 Elm Street
Westfield, N.Y.   14787

check-in and registration is 7:30-8:45 am at Eason Hall, 23 Elm Street, Westfield
This form can be printed using your browser's print function
One rider per form
RELEASE:  (required)
In consideration of the acceptance of this entry, I wave for myself, my heirs and assigns, all and any claims for damage which I may have against the TOUR, its directors, sponsors, or any other organizations or individual as a result of any and all injuries I may receive during the event.  I attest that I am physically fit to participate.  I release any photos that may involve myself, and I give permission to provide medical treatment to me in case of injury or illness.

Name of person signing:
(Parent or guardian of under 18 years)


Relationship:




Date:



By clicking here , you attest to the truth and validity of the above information. You will be asked to provide a written signature upon arrival.



Do you plan to eat lunch at the Episcopal Church?
T.-shirt size -  choose one.

No size substitutions on ride day
If no choice marked, rider will receive a large.

Phone number
Male
Female
Father
Mother
Guardian
Self
I AGREE
yes
no
S
M
L
XL