TestRegistra

COASTAL CRUISERS BICYCLE CLUB
2009 PASTA BASH REGISTRATION

Please provide the following registration information. See privacy statement below.
A separate form must be used for each registrant.

First Name

Last Name

Street Address

City

State or Province

Zip

Country

Phone with area code first (111) 222-3333

E-mail

Select One
Membership Status CCBC Member
Non-Member

Fee Information
Select one below: $10 - Wine & Cheese Social only

$35 - CCBC Member late fee after Nov 3

$40 - Non-member late fee after Nov 3

T-Shirt Size
Select one below: N=No Tee for Wine & Cheese Social Attendees
S=Small M=Medium L=Large
XL=X-Large XXL=XX-Large

Please review your information and when satisfied your data is correct, press the "Next Step" button below.

To start over, press the "Clear all fields" button below.

Privacy: The data you enter here is stored temporarily in a secure, private folder on this web site and then transferred to an external hard drive for use only by the Coastal Cruisers Bicycle Club Pasta Bash registrar. None of the data will be sold to commercial businesses or made available to any organization or person not involved with the Coastal Cruisers Bicycle Club.

First Name
Last Name
Street Address
City
State or Province
Zip
Country
Phone with area code first	(111) 222-3333
E-mail
Select One	Membership Status CCBC Member Non-Member
Fee Information Select one below:	$10 - Wine & Cheese Social only $35 - CCBC Member late fee after Nov 3 $40 - Non-member late fee after Nov 3

T-Shirt Size Select one below:	N=No Tee for Wine & Cheese Social Attendees S=Small M=Medium L=Large XL=X-Large XXL=XX-Large

Sally EntlichCopyright © 2009 [Coastal Cruisers Bicycle Club]. All rights reserved. Revised: 11/14/09

Sally Entlich
Copyright © 2009 [Coastal Cruisers Bicycle Club]. All rights reserved.
Revised: 11/14/09