2017 OOS REGISTRATION FORM
(PLEASE PRINT CLEARLY. One person per form. Form may be duplicated & emailed)
Print form, fill out completely, and send with check or money order payable to Out of Staters – or – OOS!!!
Print form, fill out completely, send in, or email and pay by credit card
We will confirm all baggage tag numbers with the info you provide on this form; please fill out completely. You must provide birth date to check RAGBRAI tag number.
❑ Full Service @$305.00 with transportation on July 22 (Cash/Check $295)
❑ Transportation Only @ $155.00 with trans. on July 22 (Cash/Check $150)
❑ Baggage Support Only All Week @ $165.00 (Cash/Check $160)
❑ Baggage Support Only @ $25.00 per day for ____ day(s)
❑ Full Service @$305.00 with transportation on July 29 (Cash/Check $295)
❑ Transportation Only @ $155.00 with trans. on July 29 (Cash/Check $150)
RAGBRAI Baggage Tag Number (wristband #) ________________ (if you register before May 1st this number must be emailed when issued by RAGBRAI)
Registrant’s Date of Birth – required to verify wristband # ____________________
Traveling with (if anyone)____________________
Release: In consideration of the OUT-OF-STATERS’ BICYCLE CLUB’S acceptance of my registration to participate in RAGBRAI XLV, I hereby for myself, my heirs and assigns: release, indemnify, and agree to hold harmless the OUT-OF-STATERS’ BICYCLE CLUB, it’s directors, officers, employees, agents, and participants who may be performing functions for the ride, from any and all actions, claims, demands, administrative proceedings, judgments or decrees, including attorney’s fees of any kind that may arise our of my participation in RAGBRAI XLV.
Signature of Registrant
Signature of Parent/Guardian if Under 18
Tim Haeffner 18712 125th St., Danville, IA 52623 We will confirm receipt of payment by e-mail. If you don’t have an e-mail address, include a self-addressed, stamped business size envelope.