SARANAC LAKE TANDEM RALLY - SLTR 2015

SARANAC LAKE TANDEM RALLY
1 Dahinda Rd
Saranac Lake, NY 12983
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For three days: 
Fri. June 19th to Sun. June 21st - $85 per Tandem Number Bikes: ___ Total: $________
Or for one day:
Sunday June 21st only - $40 per Tandem        Number Bikes: ____ Total: $___________


Total Registration (Please make checks payable to "Gear-To-Go").........$___________ 
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Participant Info:    Captain                                  Stoker

Name: __________________________________      Name: ________________________________

Address: _______________________________      Address: (If Different) ______________

________________________________________      ______________________________________

City: __________________________________      City: ________________________________

State: ________ Zip Code: ______________      State: ________ Zip Code: ____________

Phone: _________________________________      Phone: _______________________________

E-Mail: ________________________________      E-Mail: ______________________________

Emergency Contact:                            Emergency Contact:

Name: __________________________________      Name: ________________________________

Relationship: __________________________      Relationship: ________________________

Phone: _________________________________      Phone: _______________________________

MINORS: Names, Ages, Relationship: _________________________________________________

MINORS: Names, Ages, Relationship: _________________________________________________

Tandem make: __________________________ Model: _______________________  Year: ______