PLEASE PRINT ONE FORM PER PERSON

Category (Class) Check One	Registration Fee After July 1^st, add $5 per rider	Amount ($)
� Class 1 – 48 miles R/T � Class 2—24 miles from Ft. Calhoun, NE to downtown Omaha � Class 3 –10-24 miles R/T U-pick	$20 (under age 18 is $15)	$_________
� Tandem Riders – All routes (one form/person)	$18 per rider	$_________
Wine & Cheese Tasting Event Update message		$_________
Donation	Enter Amount. For more information, contact: Tour d'Omaha	$_________
Total Due		$__________

By Pre-registering before July 1^st, you will receive one T-shirt per entry. Please indicate size;
After July 1^st, T-shirts are subject to availability. Register Soon!

� Small � Medium � Large � X-Large � XX-Large

Name: ________________________________________________

Family/Group/Team Name: ________________________________Free Prize Drawing!

Street Address: ______________________________________________

City: ______________________ State:___________ Zipcode:_________

Day Phone#: ( )_______________ Evening Phone#: ( )_______________

Fax#: ( )__________________ E-mail: _______________________________

Emergency Contact Name: __________________________ Ph. # _________________

� I am OVER 18 years of age and I have read and agree to the Waiver & Release or

� I am under 18 years of age and my parent/guardian has read and signed the waiver and release on my behalf.

All riders must have a signed waiver on the day of the ride.

Signature: _____________________________ Date: ________________

Print One Registration Form Per Person. Make check payable to: Tour d’ Omaha.
Mail completed registration form, signed waiver & release, and check for total amount to:

Tour d’ Omaha

PO Box 8434

Omaha, NE 68108-0434