2019 Cycling for Autism Rider Registration First Name Last Name Phone Email Address Street Address Line 2 Town/City State/Providence Zip/Postal Code T-Shirt Size Small Medium Large XLarge “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 32 mi 16 mi 12 mi 6 mi Virtual Rider Rider Waiver The Waiver You are required to sign a waiver. Download Waiver Have you downloaded the waiver? Yes Price Admission $40.00 Payment Options 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. Submit Form Notices
