2020 Cycling for Autism Rider Registration

First Name

Last Name

Phone

Address

Street Address

Line 2

Town/City

State/Providence

Zip/Postal Code

T-Shirt Size

“If registering a child under 12, simply select “Pay by Check” and mail a check for $10/child to cover the child’s lunch only.”

Riding Distance

Distance

The Waiver

You are required to sign a waiver. Download Waiver

Have you downloaded the waiver?

Yes

Admission $40.00

Credit Card

Pay with Check

Mailing Address: Tampa Interbay Rotary PO BOX 320843 Tampa, FL 33679-2843. Please make check payable to Tampa Interbay Rotary Foundation.