THE BUCKY 4 DUAL SPORT RIDE!
OCT. 27th, 2012
REGISTRATION FORM
Print this page, fill it out, and send it in with your check.
Your printer's busted? No problem. Just write down the info on a sheet of paper and send it in!
PLEASE NOTE: ALL REGISTRATIONS RECEIVED AFTER OCTOBER 10, 2012 WILL BE RETURNED.
NAME:__________________________________________________________________________
ADDRESS:_______________________________________________________________________
CITY________________________________________________ STATE _____ ZIP___________
E-MAIL________________________________________________ PHONE ___________________
AMA # (if applicable)_________________ District 16 member? _____Yes ____No
BIKE brand/model___________________
LIC PLATE #________________________
CIRCLE T-SHIRT SIZE (no pick gets XL) : S M L XL 2XL 3XL 4XL (a.k.a. the "Big Tony")
Entry is $70.00/rider, includes meals and t-shirt.
Non-rider meal ticket is only $10.
Make check payable to Madison M/C.
Please mail check and registration info to:
Bucky 4
c/o John Troia,
2898 Glacier Valley Rd., Fitchburg, WI 53711
THANK YOU! Proceeds go to help local causes/charities. We appreciate your participation!