Finger Lakes Randonneurs
Central and Western NY Region
Rider information and Registration for 2021 Western NY Water Falls 1,000k/1,200k
Please be accurate. This information will be used to pre-print your waiver and brevet card, and to mail back your brevet card
Note: For security reasons, none of this data is held on line
Any questions, contact me!


When you hit "Send" at the bottom it is e-mailed directly to the RBA.
If you don't have a response me within a few days, please contact me!!

First Name: 
Last Name: 
Street Number: 
Street: 
City: 
State/Province (2 letter abbreviation): 
Zip/Postal code: 
RUSA # (mandatory):  RUSA membership is mandadory!!
Your E-Mail Address: 
Home Phone: 
Cell number during ride: 
Emergency contact name(s): 
Emergency contact phone number(s): 

Type of bike you'll be riding:  Single    Tandem    Other    
Partner, if riding tandem: 


We'll stock the support car with 700c/650b tires and tubes. If you're riding something else, please check this and describe in the "Anything else you'd like me to know?" box, and we'll stock up.

Distance you'll be riding:  1,000k 1,200k
May be changed up to check in

Will you be fully vaccinated against COVD19 at least 14 days before the ride start?  Yes No

T-Shirt size:  XS S M L XL XXL

Dietary restirictions? 
        
For "Other" please describe in the "Anything else you'd like me to know?" box.

Optional identifying information, just in case....
Sex: Male Female
Age: 

Anything else you'd like me to know?

When you click "SEND" an e-mail will be sent to me with this information, and I'll add you to my database.
Once I've done that, I'll e-mail you a confirmation.



Last change May 23, 2021