or CLICK HERE if you want to see a pretty version of this form

Labor Day Classic & Sunrise Century
Combined Registration Form
www.clarksvillecentury.com
Please print clearly, sign the release, and return this form to:

Sunrise Century, P.O. Box 1352, Clarksville, TN  37041-1352.

Enclose a non-refundable check or money order payable to Clarksville Sunrise Rotary Club.
On-site, late registration is also available on ride day for the fee shown below.

One person per form, please.

_____________________    _______________   _____   _________________
LAST NAME                FIRST NAME        M or F  PHONE NO.

 ________________________________________   ________________________        
ADDRESS                                     EMAIL              

____________________   _____    __________   ___S ___M ___L ___XL ___XXL
CITY                    STATE     ZIP        SHIRT SIZE

Please Register Me             Pre-Register Pre-Register  Late Registration
For The Following Ride(s):         Fee        Deadline          Fee

___ 33-Mile (August 30, 2008)      $25          Aug 23          $35

___ 62-Mile (August 30, 2008)      $30          Aug 23          $40

___ 100-Mile (September 20, 2008)  $35          Sep 7           $45

___ Both 62-Mile & 100-Mile        $60          Aug 23          N/A

___ Extra T-Shirt(s) $10 each  Size(s): ___Sm  ____Med ___ Large ___X-Large ___ XX-Large

Total Due and Payment Enclosed: $ ____________

-------------------------------------------------------------------------------------------------------------------------------

I agree to abide by all Clarksville Sunrise Rotary Club rules. I waive claim for myself or anyone acting through me against
the organizers and sponsors of the event for any harm or loss suffered through my own, or my child’s participation in it.
I certify this applicant is deemed fit to participate in this physical event. Riders under the age of 16 must be accompanied
by an adult rider.

 ____________________________________________________________________     _________________
 SIGNATURE OF RIDER OR, IF UNDER 18, OF PARENT OR GUARDIAN                   DATE
(You Will Be Required To Sign Another Waiver At Registration The Day Of The Event)