Print and complete this form. Make checks payable to: “Sprint Selzer Bicycle Club” (SSBC)
And mail to: Ann Chalfant, 611 6th Ct NW, Bondurant, IA 50035
By June 15, 2012!!!! The Bus will arrive at Union Station (Mackey’s bar), at 1724 16th Avenue SW, in Cedar Rapids, Iowa, at 9 a.m. on Saturday, July 21, and will depart approximately one hour later (10:00AM). Questions, call Dennis Thompson or Mackey at 319-365-2146. If there are seats available, we will sell them to the public after July 1. The baggage hauling, beverage, snacks, and driver fee is $140.00 for the entire week, or $20.00 per day, if you can’t spend the entire week on the ride. Please pay the week-long fee if you spend more than three days with us. The bus fee is just for those riding out on the bus. Please remember to send one of these forms to anyone who does not have Internet. You will also be able to download the form from the Team Sprint website (http://teamsprint.org).
This order form is for Name(s) _______________________________________________________
Address _____________________________________________Phone #:___________________
Note: T-shirts will be distributed at RAGBRAI. The design will be printed on a yellow haze-colored shirt or a gray tank top. You can see the designs at: http://www.brokenarrowwear.com/artApproval/art-display-201205/377.html
ITEM
QUANTITY
SIZE(S)
COST
TOTAL
BUS FEE
$75.00
Check: O - Cedar Rapids OR O – Des Moines
WEEK-LONG BAGGAGE / REFRESHMENT FEE
$155.00
DAILY BAGGAGE / REFRESHMENT FEE
$25.00
2012 SLEEVED T-SHIRT S-XL YELLOW HAZE
$17.00
2012 SLEEVED T-SHIRT XXL-5XL YELLOW HAZE
$19.00
2012 LONG-SLEEVED T-SHIRT S-XL YELLOW HAZE
$18.00
2012 LONG-SLEEVED T-SHIRT XXL-5XL YELLOW HAZE
$20.00
2012 TANK TOP S-XL GRAY
2012 TANK TOP XXL ONLY GRAY
$21.00
GRAND
(ALL MEN'S STYLE/SIZED SHIRTS)