*
Required Fields
Tour de Burren Registration
Race Date: Saturday, June 20th 2009
Please have you Credit Card ready for secure payment with PayPal
note:You
DO NOT
need to have an account with PayPal to finalize payment
Participant Information
First Name:
*
Last Name:
*
Address:
*
Date of Birth:
*
Example: DD/MM/YYYY
Club:
E-mail:
*
Example:
[email protected]
Phone Number:
Mobile Number:
T-Shirt Size
Please select...
S
M
L
XL
Race Distance
Select Distance:
*
Please select...
60km Cycle
160km Cycle
The cost of entry is
€30
for both the 60 Km and 160 KM cycle.
Need assistance with this form?