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Rider Information:    * First Name:      * Last Name:     * Address #1:     Address #2: * City:     * State:   Texas Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Deleware Florida Georgia Hawaii Idajo Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minneosta Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire Newfoundland New Jersey New Mexico New York North Carolina North Dakota Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming   * Postal Code:     * Birth Date: (MM/DD/YYYY)     * Phone:     * Email Address:       If Corporate Rider, Name of Organization: * I plan to Ride:  1019364675100   T-Shirt Size Small Medium Large X-Large XX-Large   Rider Type:  Individual Rider - $20 Family Ride (4 Riders per address) - $15 Corporate (8 Riders with same Organization) - $15     * Extra's Select Item Quantity Extra T-Shirt ($10) White Tank Top ($10) White CoolMax T-Shirt ($25) Size   Small Medium Large X-Large XX-Large   Small Medium Large X-Large XX-Large   Small Medium Large X-Large XX-Large Did you ride last year?  Yes No, but I have ridden before No, this is my first time How did you here about us? Bike Club Bike Shop Burleson's Pure Honey Chamber of Commerce Citizens National Bank Internet Mailing Newspaper Other www.bicycletexas.com Please select a value