Bicycle for Life

TC1200 Application!

2012 Pre-Registration
is at the bottom of this page

To pre-register for the TC1200 or TC1000k, please use our online application info form.
Fill in all blanks and submit the form which will temporarily hold your spot.
Your TC1200 or TC1000k 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 Tuesday August 28th 2012 at packet pickup.

Pre - Registration is open. Rider slots will be filled based on payment in full date.
Lists of your TC1200 or TC1000 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 TC1200 and TC1000 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 TC1200 TC1000k
April 1 200 125
May 1 225 150
Jun 1 250 175
July 1 300 200
Aug 1 350 200
Aug 15 375 225
Aug 28 400 250
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)

You can also log in to your PayPal account and send a payment to
info.donation bicycleforlife.org

Please keep in mind when you use your credit card, we will be charged a fee for that service, so please consider adding 5% to your total to cover the expenses for CC use.

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- You may cancel by notifying us by email

Your refund will strictly be based on the following
for confirmed riders (subject to change):

* Before April 1: full refund minus PayPal, Bank and/or mailing fees
* Before June 1: full refund minus $20 & any transaction's fees
* Before July 1: full refund minus $50
* Before Aug 1: full refund minus $100
* Before Aug 15: 50% refund.
* Thereafter: no refund.

NO REFUNDS after 24 Aug 2012
The ride will start Aug 29 2012 at 4:00AM, rain or shine.

Qualifications

You may apply before qualifying. If you have not yet qualified, note this on your application,
and give us the details when you do complete qualifying.
If you have not qualified by Aug 15th, your spot for the event may be lost
and may only be refunded according to our Cancellation & Refund statements.

All entrants to the TC1200 should meet the following the following qualifications:

* Successful completion of a 200, 300, 400, and 600 kilometer brevet series
in either calendar year 2011 or in 2012 prior to the start of the TC1200 or TC1000
or completed a 1200k within the previous 2 years or a 1000k within the last year.
o Qualifying events may be a mix of ACP brevets 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.

Bicycle for LIfe
Brevets Salisbury, NC USA
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 2012)
Club Name
Club ACP #:*
(lookup your
Club ACP #)
Non RUSA #:
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: *
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

TC1200 Weekend
Aug 29 1200 km RM Brevet Mountains/Coastal
Aug 29 1000 km RM Brevet Mountains/Coastal













Cost

Full Payment Before TC1200 TC1000k
April 1 200 125
May 1 225 150
Jun 1 250 175
July 1 300 200
Aug 1 350 200
Aug 15 375 225
Aug 28 400 250

Registration Pledge:*

Please send in your pledge as soon as possible

Credit Cards are only accepted online through PayPal via our Donate Page

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

Please keep in mind when you use PayPal we will be charged a fee for that service, so please consider adding 3% to your total to cover the expenses for PayPal use.

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
When do you plan submit your payment for the event you are entering? 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

Jerseys are included in cost

1200k medals are included for finishers!
Qualifying events: *

To look up your past results for RUSA use this link and enter your RUSA number into their form.
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.
IP Address:
Used for reporting
Spammers

Home • About Us • Events • Needs • Contact
Join • Donate • Sponsorship • Volunteer • Links

Site content © 2005 Bicycle for Life
Page layout © 2005 Goodnight Art & Design , All rights reserved.
No part of this site or content may be copied or reproduced without !
All logos and trademarks on this site are property of the respective owner!