* This form is for those who would like to register individually and be placed on a team with other individual registrants to form a new team. We will assign you to a team and inform you once the team is complete, who is on the team, and how to contact your new teammates. You will specify if you want to be on a 2 or 4 person team, and 'Race' or 'Fun' team below
Team Name: May or may not be used.
Team Captain: Yes No Are you willing to be Captain of your Team?
Teammates: Are there 2 or 3 of you? Put your friends name(s) here.
Race Category: Race Fun We'll do our best to get you in your desired category.
Team Size: 4 Lady 2 Lady We'll do our best to get you in your desired category.
Name:
Address:
City:
State:
Zip:
Phone:
Email:
Birthdate:
Buy a Jersey? Yes, $50.00 No Thanks Quick view of Jerseys
Jersey Size: XS S M L XL XXL 2012 Jersey Sizing
Buy Shorts? Yes, $70.00 No Thanks
Shorts Size: XS S M L XL XXL 2012 Jersey Sizing
T-Shirt Size: XS S M L XL XXL *T-Shirt is Free!
Would you like to buy a Metal Rockwell Relay Finishers Watch?
0 1 X $200.00 each Quick view of Metal Watch
Would you like to buy a Leather Rockwell Relay Finishers Watch?
0 1 X $100.00 each Quick view of Leather Watch
Buy a Teamgive watch? (proceeds go to charity!)
0 1 X $250.00 each Quick view of Teamgive Watch
How did you hear about the Rockwell Relay?
Web search / browsing Friend Bike shop poster Cycling calandar of events At other cycling event Facebook Previous Rockwell Relay Participant Other
Did someone refer you to the Rockwell Relay?
Comments / Special Instructions?
Things an announcer may say about you.
Have you read and agree to the Waiver and Release of Liability.
Please Note: You will pay online through Google Checkout on the next page.
Before continuing, make sure all fields are filled out and your Total is accurate.
