Make checks payable to NGBDA
Mail to Perpetual Motion Bicycles, 1002 Maple Street Carrollton, Ga 30117

Amount Included________
($25 per person by October 8, add $5 if postmarked after October 8.

Name___________________________________________________

Address___________________________________________________

City______________________ State________ Zip______________

Phone_________________________ Email Address__________________________________

Please add me to your email list for future ride info. Yes___ No___

T-Shirt Size Check One: Small__ Medium__ Large__ XL__
T-shirts guaranteed to pre-registered riders only with entry postmarked BEFORE October 8.
T-shirts will be available for pick-up at the 'pre-registered' table the day of the event.
.

Distance Option in Miles Check One: 25__ 40__ 65__ 100__
Please check one so we can better prepare the sag stops.
It is not mandatory for you to ride the distance you select here.

In consideration of my participation, I agree not to hold the North Georgia Bicycle Dealers Association (NGBDA), or any other agent or representative of the 'Madison Century' liable for any injury or damage, however caused, which may result from my participation. I understand that additional waivers may require my signature on the day of the event.

Signature________________________________________________

Parent/Guardian if under 18__________________________________

''Day of'' Registration opens at 8:00am and Ride Starts at 9:00am October 19, 2008
Sag stops and mechanical assistance provided on all routes.Courses will be marked and maps provided. T-shirts to all pre-registered riders. Ride will be held rain or shine - NO REFUNDS!

Monies raised by the NGBDA are used to fund cycling advocacy in Georgia.

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