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Firecracker Ride 2022 Registration Form
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Price Schedule
Through
05/31/2022
Through
07/01/2022
Final
Firecracker Rider - PLEASE READ confirmation email if registering June 29 or later!
$45
$50
$55
Categories
*
Firecracker Rider - PLEASE READ confirmation email if registering June 29 or later! - $50.00
Participants/Riders who want to choose their own donation amount to fight MS! Scroll below to enter your own donation amount.
I am NOT riding ( or I already registered ) and I just want merchandise
CLOSED
Participant Information
Participant Email
*
Participant First Name
*
Participant Last Name
*
Participant Birthdate
*
- month -
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- year -
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- year -
Participant Gender
*
Male
Female
Prefer Not To Say
Country
*
-- select country --
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Street Address (w/Apt#)
*
City
*
State
*
-- select state --
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-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
Nevada
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New Jersey
New Mexico
New York
North Carolina
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Ohio
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Oregon
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Zip Code
*
Phone
*
Would you like to
receive important event text alerts
on this number (eg. changes or delays)?
Emergency Contact Name
*
Emergency Phone
*
What distance are you riding?
*
100K ( ~62 miles )
60K ( ~39 miles )
30K ( ~18 miles )
Affiliated Club, Team, or Organization
-- select your club or team --
- I am not a member of a team -
12th State Cycling Team p/b Trophy Brewing
Adobo XP
Allied Automation
Amazon
Bull City Burn
Capital Cycling Club
Carolina Arbors Cycling Club
Cool Kidz Cycling
Coop's Troops
CPR Realty Team
Cross Creek Cycling Club C4
DMR (BeanCulture)
Easy Riders
Endurance Edge
Fahrenheit Group
Greenway Cyclist of the Triangle
GSK
Gyros
Houndstooth Cycling
Jamhuri
Jigawatt Cycling p/b Carolina Ale House
Latino cycling club
le Tour de Femme
Linville Babes
Los stars
Massage Envy Racing (Koeles Cycling Club)
MCM Riders
MS 200
MSing Links
North Carolina Bicycle Club (NCBC)
Oak City Cycling Project Race Team
OGRE's (Old Guys Ride Early)
Old North Cycling
On Draft
Otterhaus Cycling
Outrageous Cycling
PAKLAYBOYZ
Rescue Project Racing
Revolution Cycle Sports p/b Lonerider Brewery
RIDE MANIA
RRT4G
SCC
Selma Cyclepaths
Siemens - Wendell
Sikad NC
SPRC
Stars pro-Cycling Team
Tarwheels
Team ADL
Team All Star
Team Bicycle Chain
Team CBC
Team Cheetah
Team Flow Cycling
Team Gruppetto
Team Pinkie
Team RWB
Team Spoke Cycles
Team Zoot
TeamCBC
Test Add New Team
Triangle OTG
Triangle Triathlon Club
Wallaby Tikka Masala
Wave 1 Performance
Yardnique
ZAP Endurance Coaching
add new team
new team name
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Donations to National MS Society
Please help us to help the National MS Society of Greater Carolina's with your donation. No amount is too small. THANK YOU!!
(
click here
, to learn more about this cause)
Amount $
Or you can choose an amount from this list! Thank you!
$25 Donation
$35 Donation
$50 Donation
Event Merchandise - Online ordering closed as of June 1, 2022
Waiver
*
I have read and agreed to the
waiver
*
Is the participant 18 or older?
*
18 or older
Under 18
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian.
If registering a child under 18, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
Parent's signature
Payment Details
Discount or Tracking Code
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Do not COPY & PASTE the code, please type it into this field.
Price
$
Discount (-)
$
Donation
$
Total
no handling
$
Handling
$
Total
$
Payment Method
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2. Make sure you enter the code,
52555
in "What's it for".
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