I will call 704.889.1458 to pay by credit card.

I will pay online using shopping cart

"; } $form[18] = nl2br("$form[18]"); $form[20] = nl2br("$form[20]"); $form[23] = nl2br("$form[23]"); $form[24] = nl2br("$form[24]"); $form[25] = nl2br("$form[25]"); $form[26] = nl2br("$form[26]"); ?>

Camp Signup Form

Name:

$form[0]

Address:

$form[1]

City:

$form[2]

State:

$form[3]

Zip:

$form[4]

Country:

$form[5]

Daytime Phone:

$form[6]

Contact Phone:

$form[7]

E-mail:

$form[8]
   
Please be sure to choose a 2008 camp  
Camp:
   
Agreed Ip Address: $paymentpolity I have read, I understand and I agree to the Payment and Cancellation Policy by clicking on this button.
   

 
Agreed Ip Address: $liability I have read this liability waiver fully, understand that it is legally binding, and accept the terms freely and voluntarily by clicking this button.
   

Payment Method:

 $payment
   

Emergency Contact During Bike Camp:

Name:

$form[9]

Relation to you:

$form[10]

Phone:

$form[11]

Alternate Phone:

$form[12]
   

Cycling Background/Camp Questionnaire:

 

Have you attended Totalcyclist/Per4mance Training Camp before?

 

$attend

If yes, when?

$form[13]

Birth Date:

$form[14]

Height:

$form[15]

Weight:

$form[16]

Unisex t-shirt size:

$tsize

Na/ for 1st Jersey
size:

($75 added to your bill)

N/a for first camp hide?Bike shorts
Sugoi size:

($75 added to your bill)

Arm Warmers
DeFeet size:


Socks
DeFeet size:

$socksize

Experience Level:

$experience

Fitness Level:

$fitness

Describe your fitness:

What type of bike do you ride?

$form[18]

How often do you train in a group?

$form[19]

Weekly summer mileage:

$form[20]

Average training speed:

$form[21]

Goals for camp:

$form[22]

Food allergies or dietary concerns:

$form[23]

Medical concerns we should be aware of:

$form[24]

Comments:

 $form[25]