Ride Registration

02/01/12

Welcome to the Jack & Coke Bike Ride 2012
Registration
- Online Registration - ONLINE REGISTRATION for 2012 is NOW OPEN! You can still register at the START LOCATION Saturday, May 12 - registration opens at 7AM. Fill out the form below and select the "Submit" button. You will be re-directed to the "COMPLETE REGISTRATION - PAY ONLINE" page. Select the PAY NOW button to complete the registration process and pay your registration fee online through PayPal. You will need a credit card to pay online.
- Mail Registration - Select this LINK to the PDF of the form, print the form, fill it out and mail completed form and check for the entry fee to the address below.
Jack & Coke Bike Ride
13319 West 103rd Terr.
Lenexa, KS 66215

Online Registration Form

Type your information in the fields below and select the "Submit" button to proceed to the PAYMENT step. To complete registration and payment online, you will need a credit card or a PayPal account. If you prefer to register and pay by mail, select the Mail Registration LINK above, print the PDF registration form, fill it out and mail it and your check for the registration fee to the address above.

First Name: Last Name:

Address:

City: State: Zip:

Phone: Email Address:

Your age on day of ride (May 12, 2012):

Registration fee:$ 30.00

T-Shirt Size: S M L XL XXL

T-shirts and beer glasses guaranteed only for early [by April 24] registrants.)

Route I plan to ride : 15 25 48 55 64 71

You may edit individual fields before submitting the form.

Select the "Submit" button to proceed to the PAYMENT step.

Select the "Clear Form" button to clear the form and start over.

A SIGNED WAIVER IS REQUIRED FOR YOU TO RIDE. PRINTED COPIES WILL BE AVAILABLE ON THE DAY OF THE RIDE AT REGISTRATION. YOU CAN DOWNLOAD THE WAIVER BY SELECTING THIS LINK. Print the waiver PDF, fill out the form, sign it and bring it with you to the ride.

Make registration entry fee and donation checks payable to: Jack & Coke Bike Ride

If you print the registration form, send the completed form and entry fee check to the address below. If you register online, your payment will be processed through PayPal and your credit card.

Mail TO:

Jack & Coke Bike Ride

13319 West 103rd Terr.

Lenexa, KS 66215

Waiver
- DOWNLOAD THE WAIVER PDF BY SELECTING THIS LINK
Contribution - Coming soon - online contributions through PayPal
- Want to collect fund-raising contribution pledges from friends & family?
  - Select this LINK and print the PDF of the Jack & Coke Pledge Sheet to keep track of your pledges

This site was last updated 02/01/12