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Riptank Open 2011 Registration

Contact Information:

First Name: Last Name:

Phone Number:
Email Address:

Address Information:

Address Line 1:
Address Line 2:
City: State: Zip Code:

Emergency Contact Information:

Contact Name:
Phone Number:
Contact Relation:

Division Entering:
Youth $40
Beginner $40
Intermediate $40
Advanced $40
Expert $40
Outlaw $100

Rider Bio

Please fill out this form so that our announcer will have some interesting things to say during your run.

Gender: Age:

Board:

Bindings:

Years Riding:

Favourite Trick:

Favourite Rider:

Where and with whom do you ride with?

How long have you been riding?

Anything else you would like to add:

*Entry fee for all divisions except Outlaw is $40
**Entry fee for Outlaw is $100