PEDAL PUSHERS CLINIC REGISTRATION FORM by AndrewBrocklehurst

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									         PEDAL PUSHERS CLINIC REGISTRATION FORM
CYCLIST INFORMATION

Name:_____________________________________Date of Birth(D/M/Y)_____________Age__
Address:______________________________City____________Prov___Postal Code________
Health Card #:____________________________Email________________________________
Home Phone:____________________________ Cell__________________________________

Allergies/Medical Conditions:_____________________________________________________
Emergency Contact Name ______________________________________________________


CLINIC NAME & DATE (please circle)
PEDAL PUSHER SUPREME: $200.00 Includes instruction, guiding, cyclist lunch, snacks,
spa pass & goodie bag
                    th
August 15 & 16
            th
Sept 12 & 13

DIVA DAY CLINIC: $130.00 Includes instruction, guiding, cyclist lunch, snacks, spa pass &
goodie bag
         th   th
August 15 , 16 , Sept 12, Sept 13th

FALL FIESTA ROAD TOUR: $ 95.00 Includes lunch/snacks
October 3rd

Paid by:             Cash                            Cheque                          Paypal

Please make cheque payable to Noelle Wansbrough or send payment via email to
nwansbrough@rogers.com, Form can be faxed to 416-488-8631. Mailing address: 11 Woodview
Drive, Collingwood, ON L9Y 3Y9.

ENSURE YOU READ THE FINE PRINT Once your clinic or tour registration and payment are received you will receive an
email confirmation securing your spot in the clinic/tour. You will also receive your clinic day itinerary and a skill level
questionnaire. Clinics run rain or shine. Cancellation policy: A credit for another clinic of the same value will be issued or a
refund of clinic price minus 35% processing fee is available up to 5 days before the camp date. After this time there is no
refund - no exceptions. Each participant MUST fill out and sign all pertinent waivers before participating in our clinics and
tours.

        “Think of bicycles as rideable art that can just about save the world” – Grant Peterson

                                           www.pedal-pushers.ca

								
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