Participant Information

* indicates a required field.




*Name:  
*Address:  
          
*City:  
*State/Prov.:      *ZIP/Postal Code:
*Country:  
Phone:  
Birthdate:       Gender:   Male Female
 
RUSA Nr: Membership Pending
Other Org.:
e.g., Audax UK

Emergency Contact:  
Relationship:  
E-mail:  
Phone:  

Distance: 1200km 1000km I will have personal support.
  I have completed these 1200km+ Grand Randonnées: Recumbent     Fixed    Tandem, partner*:
            * Requires separate application and payment.

QUALIFICATION - List brevets you have ridden since July 1, 2018 to qualify for the High Country 1200. If you have ridden a higher-distance brevet to substitute for a lower distance or other agreed-upon substitute(s), note that under "Event Distance". If you are applying prior to full qualification, send an e-mail listing your remaining qualifying info when you've completed your qualification.

Distance Date Location Elapsed Time Certificate Nr. Event Distance
200km
300km
400km
600km
1000km
otherm

WAIVER - By submitting this application, I acknowledge that I understand this waiver's intent, and I for myself, my heirs, executors, administrators, and representatives, do hereby agree to absolve and hold harmless the Rocky Mountain Cycling Club, Randonneurs USA, and any other parties connected with this event/these events in any way, from and against any blame and liability for any harm, loss, inconvenience or any other damage of any kind whatsoever, which may result from or be connected in any way from my participation in this event/these events. In addition to the absolute and unqualified release from all liability, I hereby represent that I am physically capable of participating in this event/these events; that my bicycle and any other equipment I may use is in good working condition; that I will observe all applicable traffic and event rules; and that I will wear a helmet and conduct myself in a safe and prudent manner while participating in the event(s); that I undertake these rides as personal bike tours and take responsibility for my own safety. I further agree to abide by the rules for riders of brevets. I certify that I have read this waiver and release, and understand its significance.

Continue your registration by clicking Next.




THIS WILL BE THE CONFIRMATION PAGE - STILL UNDER CONSTRUCTION


‡If you are not a current RUSA member, join/renew online.
If you are not a current RMCC member, join/renew online (preferred), or print the membership application
and either mail it in or bring it, along with a check for the membership fee, to the ride start.