Central and Western NY Randonneuring
Rider information form
Note: None of this data is held on line!

First Name
Last Name
Street Number
State/Province (2 letter abreviation)
Zip/Postal code
RUSA # (blank if not a RUSA member)
Your E-Mail Address
Home Phone
Cell number during ride
Emergency contact name
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 March 8, 2016