Name (Print)___________________________________________________________________________
Address _______________________________________________________________________________
City______________________________________________ State________ Zip__________________
T-Shirt Size: [Circle one] S M L XL XXL $20 pre-registration is due by Oct. 8.
Telephone:__________________________ E-Mail: _________________________________________
Route [Circle One] 10 mile ride 20 mile ride 30 mile ride 46 mile ride Century Ride 
Mail Registration to: Fran Morrell
106 South Byrd
Tishomingo, OK 73460
(580)371-3358 franmorrell@tishomingo.com
Disclaimer: Neither the Tishomingo Development Team nor any other individual or organization assumes any responsibility for any damages, injury or other problems which arise directly or indirectly from anyone's participation in this event.
Rider's Signature___________________________________________
If Under 18, Parent/Guardian's Signature__________________________________________