State Postal ABR

Bike Virginia 2004 Registration

Complete the on-line Registration form below.
Click "Add Up Total"
Click PayPal for secure payment processing
Log-in to PayPal as an existing user or sign-in as a new user with a secure password.

You're done! You will receive an immediate Confirmation fr om PayPal and a Post Card Confirmation from BikeWalk Virginia once your registration has been processed in our Williamsburg office.

First Name

Last Name

Address

City

State :

Zip

Phone Day

Phone Evening

Gender

Male Female

Age

Adult

Youth(13-17)

Child(7-12)

Child(6 and under)

Non Rider

Non rider (I am a registered "Non-Rider" and will drive a vehicle on the tour from town to town. I understand that i will not be able to drive long the biking route.)

Current Bike Walk Virginia Member

Add Bike Walk Viginia Membership to Registration

A $25 Late Registration Fee will apply after May17.

Emergency Information

Emergency Contact Name

Emergengy Contact Phone

Is this person on the tour? YesNo

T-Shirt

T-Shirt Size

Accommodation

I will camp every night

I will motel every night

I will combine camping and moteling

Motel luggage transfer

Food

I am a vegetarian.

Breakfasts (5)

Lunches (3)

Dinners (5)

Have you participated in any past BikeVirginia Rides? (if so check off the years)
1988 1989 1990 1991 1992 1993 1994 1995 1996
1997 1998 1999 2000 2001 2002 2003