Harbor Springs Cycling Classic Registration

To register for the Harbor Springs Cycling Classic, simply print this form, and mail it with your deposit to:
Birchwood Inn - 7077 South Lake Shore Drive - Harbor Springs, MI 49740
Attn: HSCC

PERSONAL INFORMATION:

Name: _____________________________________________ Age (if a child) ___________________

Address: ________________________________________________

City, State, Zip: ___________________________________________

Phone Number: _____________________ E-Mail Address: ___________________________________

Club Membership (if any): ______________________________________________________________

Emergency Contact Name: ___________________________ Phone: ____________________________

If lodging, sharing with: ________________________________________________________________

Select Route: ____ 64 miles     ____42 miles     ____ 20 miles    Select Event: ____ Spring       ____Fall

Please note: You will be required to sign a release form at the pre-ride check in.

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Shirt Style: ____ Short Sleeve         ____ Long Sleeve         
Shirt Size:  ____S         ____M         ____L         ____XL         ____XX
Child Size: ____S         ____M         ____L         ____XL
Please note: Shirt order must be received two weeks prior to the event.

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PAYMENT INFORMATION

Registration Fees: ____________________ Non-Rider BBQ Fee(s): ____________________________

Shirt(s): ___________________________ $50 room deposit (Lodging only) ______________________

TOTAL DUE: ___________________________

If you need to cancel your room reservation, the deposit will be refunded up to two weeks prior,
less a $10.00 administrative fee.

Form of Payment: ____ Cash         ____Discover Card         ____MasterCard         ____Visa

Card Number _ _ _ _   _ _ _ _   _ _ _ _    _ _ _ _       Expiration Date: _ _   /  _ _

Authorizing Signature: ________________________________________________________