Name:____________________________________ Phone______________________

E-mail address_______________________________________Fax_______________

Mailing Address________________________________________________________

Phone #  to reach me_________________________________D/O/B_______________ 

1. I am ___an avid Cyclist          ___a beginner rider           ___ occasional rider   

     2. I intend to ride ___10 miles  ___20 miles     ___50 miles                                          

3. I prefer to be notified via       ___phone      ____email       ____mail       ____fax

     4.How did you hear about Miles of Museums?_______________________________

       Your signature below sets forth the understanding and agreement of our Miles of Museums waiver. Your registration will be returned to you without your signature below.

I agree to follow all the rules set forth by Miles of Museums, and have read and agree to the on line rider Miles of Museums waiver  below holding harmless all rest areas, corporations, sponsors, organizers, volunteers, The De La Salle School, and all other locations and persons affiliated with the Museum Ride. 

Enclosed is my $30.00 pre-date registration fee.

Day of Event registration is $35.00.

Signature__________________________________________*Date_____________

Your contribution is tax deductible. Checks are payable to The De La Salle School. Thank You.          

Credit Card Type___________Card Number_________________________________

Name on card_____________________________Expiration Date_______________

Mail checks or Credit Card information  to:

Priscilla Braak 17 Bellevue Ave. Oceanside NY 11572

Signature___________________________________________________*Date_____________

CLICK HERE TO DOWNLOAD THIS REGISTRATION FORM

Helmets are being offered at a discounted rate for our riders from Bell Sports. All helmet orders must be sent in by September 11, 2005 along with your registration form.