Finger Lakes Randonneurs
Central and Western NY Region
Rider information for regular events

Please be accurate. This information will be used to automatically pre-print your waiver and brevet card, and to mail back your brevet card. What you enter is exactly what will be used.
Note: For security reasons, none of this data is held on line
Any questions, contact me!

When you hit "Send" at the bottom of this form the information is e-mailed directly to the RBA, and a copy to you.
After I've verified RUSA membership, I'll send you a confirmation e-mail with further information.
If you don't have a response from me within a few days, please contact me!!

First Name: 
Last Name: 
Street Number: 
Street: 
City: 
State/Province (2 letter abbreviation): 
Zip/Postal code: 
RUSA # (mandatory):  RUSA membership is mandadory!!
Your E-Mail Address: 
Home Phone: 
Cell number during ride: 
Emergency contact name(s): 
Emergency contact phone number(s): 

Anything else you'd like me to know?

When you click "SEND" an e-mail will be sent to me with this information, and I'll add you to my database.
Once I've done that, I'll e-mail you a confirmation.



Last change Jan. 31, 2023