The Horrible Hundred

On-Line Registration $35 Payment is with Google Checkout and Credit Card Only
Please fill out the form below. Click Submit to Process Application

First Name
Last Name
Yes Publish my name and city on the website roster list
Address
City
State
Zip
Phone #
E-Mail
Your email will be used to relay event information. Check here if you wish to opt out of receiving email for non-event purposes.
Emergency Contact
Emergency Phone
Age (if any rider under 18)
Route	35 70 100
Long Sleeve Tek T-Shirt or Polar Water Bottle	S M L XL XXL or Polar Water Bottle (Limited availability after November 1st)
Horrible Hundred Jersey Sizes limited to quantities on order.
Mens Sizes - $60.00	Sorry Sold Out
Womens Sizes - $60.00	Sorry Sold Out
My story about this event and cycling: (e.g. ridden all 30 years, met your spouse, overcame injury, funny tales, etc.)

I understand that the Florida Freewheelers, Inc. are not insurers of my personal safety or liability during this event or associated activities. I thus release them and agree to hold harmless Florida Freewheelers, Inc., its members, agents, servants, representatives, successors, sponsors, volunteers, and assignees from any and all liability ( personal and property) arising out of or connected in any way with my participation in this event (or my minor child’s participation in this event). I also agree to conset to permit emergency medical treatment as needed. I further agree to fully comply with all applicable laws and traffic regulations; to conduct my activities in a safe and prudent manner, and to wear an approved bicycle helmet and not use headphones while riding.
	By checking this box you have indicated you have read the Release Form. This will act as your signature.

Verify information is correct before hitting submit to proceed to checkout page. !!! DO NOT HIT SUBMIT twice or click REFRESH !!! or you will create duplicate entries.

On-Line Registration $35