Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Length of Trip *

Will you be riding with us for one day, or multiple days?

Thursday, 7/25

Friday, 7/26

Saturday, 7/27

Sunday, 7/28

I plan on participating in the entire ride

Registration Fee *

Costs will vary depending on the amount of activity. Payment can be made by check to: First Baptist Church, PO Box 551, East Greenwich, RI 02818 (put "Bike Trip" in the memo).

One Day - $50 (add $25 for a Jersey)

Two Days - $75

Three Days - $100

Four Days (Entire Trip) - $125