Bicycle for Life

2017 CS1200 Application!

2017 Pre-Registration
The route and plans are being worked on

If you have not pre-reg'd by Apr 28th 2017, please call 980.224.3747
to see if we can get you into the 2017 CS1200

To pre-register for the CS1200, please use our online application info form.
Fill in all blanks and submit the form which will temporarily hold your spot.

Pre-registration will close Apr 28, 2017

Your CS1200 spot will be held if your application is approved
and when we receive payment in full for the event.
An email will be sent to applicants updating them on their slot status.

You will be required to sign the waivers
on Wednesday May 3rd 2017 at packet pickup.

Pre - Registration is open. Rider slots will be filled based on payment in full date.
Lists of your CS1200 spot status will be posted on the website
and riders will be listed according to their payment status
(no amounts will be listed, just partial or full payment will be indicated).
In the event more applications are received than available ride spots,
the spots will be filled by payment in full date.

Payment in FULL must be received to get a ride spot.

In the event that you meet the application requirements and a ride spot is not available,
you will be notified that you have been placed on a waiting list.

Cost

The CS1200 ride fee amount will be dependent on when you pay in full for your spot in the event!
Please plan ahead!
Cost is subject to change if the economy has a drastic swing in the cost of holding/hosting the event.

Please pay in US dollars only!

Full Payment Before CS1200
No Jersey With Jersey
Full Payment Before Mar 15 325 400
with jersey -
may be late getting to you
Full Payment Before Apr 1 350 425
with jersey -
may be late getting to you
Full Payment Before May 1 400 475
with jersey -
may be late getting to you
Payments should be made payable to
Bicycle for Life
If you are mailing payment please send it to

Bicycle for Life
Tony Goodnight
1935 Barringer Rd
Salisbury NC 28147

Please pay in US dollars only!

Credit Cards are only accepted online through PayPal
Please add a note along with your payment indicating what it is for!

Pay now with your PayPal account

Click below to make a payment now!

(note: The button takes you to PayPal)

Payment may be made using PayPal, a good check, money order or in person with cash given to High Point RBA
Payment time will be determined as follows:
PayPal = date:time paid
Check or Money Order = date:time post marked if mailed or date:time given to RBA
Cash = date:time given to RBA

Cancellation & Refunds-

* There will be NO REFUNDS for 2017 CS1200

Qualifications

You may apply before qualifying. If you have not yet qualified
or are requesting a 'Qualification Exemption',
please note either on your application,
and give us the details when you do complete qualifying.
If you have not qualified by Mar 30th, your spot for the event may be lost
and may only be refunded according to our Cancellation & Refund statements.

All entrants to the CS1200 should meet the following the following qualifications:

  • * Successful completion of a 200, 300, 400, and 600 kilometer brevet series
    in either calendar year 2016 or 2017 prior to the start of the CS1200
    or completed a 1200k within the previous 2 years or a 1000k within the last year.
    Qualifying events may be a mix of ACP brevets and/or RUSA brevets.
    Longer brevets may be substituted for shorter events if necessary.
    In limited circumstances, the rider may apply to the RBA for other substitutions.
  • * All riders must agree to and sign Bicycle for Life & RUSA liability waivers prior to the start of the ride.
  • * All riders should be members of Bicycle for Life if you want extra insurance while participating in the events we organize
  • * All riders must pass a bike inspection the evening before the ride.
    See the schedule page for the time and location of this inspection.
  • * All riders should be physically and mentally fit enough to complete the event entered
    and have no current health issues that would prevent finishing
    or that may harm the rider by participating in the event.


To look up your past results for RUSA use this link and enter your RUSA number.

Bicycle for LIfe
Brevets Salisbury, NC USA
CS1200 Pre-Registration Form

* Required fields

Please note:
1. Approved helmets are mandatory.
2. All riders are required to check-in the day of the ride (including individuals who pre-registered).
3. All riders are required to sign a waiver prior to participating in the event.
4. Riders under 18 need parent/legal guardian signature on their registration form.
5. Riders under 16 must be accompanied by a bicycling parent or another designated adult at all times.
6. You must be at least 14 to complete this form! If you are not 14 the pre-registration will not be accepted by Bicycle for Life.
7. All RUSA rules and regulations for Brevets will be required to be followed by riders.
First Name: *
Last Name: *
Street:*
City:*
State:*

or proidence & Country

Zip:*

(5 digits only for USA)
RUSA #:*
(Member lookup)


(use none if not a RUSA member)
(use applied for if you are a new member
and have not received your number for 2017)
Club Name
Club ACP #:*
(lookup your
Club ACP #)

This line is Only if you are a Non RUSA member:
Foreign Organization

Foreign Member Number

Country
Email Address: *

Verifiy Email Address:*

Make sure you get these correct!
Phone:*

10 numbers only for USA
area code then number
no spaces or dashes
Emergency
Contact Person: *
Emergency Contact
Phone Number:*
Age of Bicyclist on start date: *
If under 18 years old
Parent or Guardian's Name
Bicycle type: * Single

Tandem

Tandem Partner's Name

Will you have a crew: *

yes no

Each crew member must sign releases and waivers
List Crew if you have a crew


Please choose the Brevets
you plan
to ride: *

Date Distance General
Location

CS1200 Weekend

May 4 2017 1200 km RM Brevet Piedmont/Coastal














Cost

Please pay in US dollars only!

CS1200
Full Payment Before No Jersey With Jersey
Full Payment Before Mar 15 325 400
with jersey -
may be late getting to you
Full Payment Before Apr 1 350 425
with jersey -
may be late getting to you
Full Payment Before May 1 400 475
with jersey -
may be late getting to you

Registration Pledge: *

Please send in your pledge as soon as possible


Credit Cards are only accepted online through
PayPal via

Please add a note along with your payment indicating what it is for!

Click here to for link to pay via Paypal


Payments should be made payable to
Bicycle for Life
If you are mailing payment please send it to

Bicycle for Life
Tony Goodnight
1935 Barringer Rd
Salisbury NC 28147


Extra CS1200 Jerseys
at $75 each
(Cost may change)

When do you plan submit your payment for the event? Please refer to the cost chart when choose your payment by date!

You must choose one date below, so we have an idea for planning, Thanks!

*

Your payment helps cover the cost & expenses related to planning, organizing and running brevets thru Bicycle for Life


Do you have any food allergies that you would like to tell us about? If so please note here!


Note: BFL will not be responsible for anything that affects you health condition. Each person is responsible for their own health!

Jersey Size

Planned Jersey sizes sizing may change if it does you'll be contacted

XS

Jersey Size

S

Jersey Size

M

Jersey Size

L

Jersey Size

XL

Jersey Size

2XL

Jersey Size

3XL

Jersey Size

4XL

Jersey Size
If you really don't want a jersey
then check this box

Check for no jersey


Extra Jersey Size

To order extra Jerseys - mark below boxes
All extra jerseys are $75 each (Cost may change),
please include the appropriate amount in your payment
if you want more than 1 extra jersey, please send an email

Extra
Jersey Size

XS
Jersey

Extra
Jersey Size

S
Jersey

Extra
Jersey Size

M
Jersey

Extra
Jersey Size

L
Jersey

Extra
Jersey Size

XL
Jersey

Extra
Jersey Size

2XL
Jersey

Extra
Jersey Size

3XL
Jersey

Extra
Jersey Size

4XL
Jersey

If you don't want an extra jersey
then check this box


Check for no extra jersey

Qualifying events: *

To look up your past results for RUSA use this link and enter your RUSA number into their form.

Requesting a Qualification Exemption. Also include details in comments below.
yes
no

Comments or Questions:

Waiver: *

Checking this box electronically comfirms that you agree to and with the waiver/release and other statements in this form in the box to the right!


Please note that you will be required to sign a wavier form prior to starting each brevet ride at the official brevet registration for each event.


By checking the box to the left,
You agree, warrant and covenant as follows:


You Must agree to this waiver to submit this form!
After you submit this form
you may print the info submitted using your browser.

Note: if you have any trouble with this form or do not here from us within a couple days after you submit this form, please send us an email

IP Address:
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