RAGBRAI XL Riders

First name:
*
Last name:
*
Wristband number:
*
Club/team name:
*
Address line 1:
*
Address line 2:
City:
*
State:
*
Zip:
*
exactly 5 digits
Phone:
*
exactly 10 digits
Cell:
exactly 10 digits
Email:
*

Registration information

North/East Hall beds:
*
($10.00 each)
Rec. Center beds:
*
($10.00 each)

North/East hall: This non air-conditioned unit has two beds per room. Within the residence hall complex you will have access to a community shower/restroom facility and a laundry room. Your fee does include a towel, however, bedding will not be provided.

Rec. Center: This air-conditioned unit gives access to floor space for you, your bike, a towel and access to a community shower/restroom facility.

Note: There is a $3.00 application fee which will be charged for filling out this form.

List all riders on your team

1. Name/wristband no.:
2. Name/wristband no.:
3. Name/wristband no.:
4. Name/wristband no.:
5. Name/wristband no.:
6. Name/wristband no.:
7. Name/wristband no.:
8. Name/wristband no.:
9. Name/wristband no.:
10. Name/wristband no.:

Confirmation email will be sent upon receipt of registration form and payment.

Any questions, please contact Sharla Gradert at (712) 722-6303 or email sgradert@dordt.edu.