2016 Texas Rando Stampede 1200/1000K registration

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Name: / Email Address:
Address: / RUSA #:
City: / State: / ZIP Code: / Country:
Cell Phone: / Other Phone: / Gender:
Emergency Contact: / Phone # / Vegetarian: (Yes) (No)
Accommodations: (Shared room/double beds) or (Shared king bed) or (Non-shared room) (Please circle one)
Travel: (Flying) or (Driving) (Please circle one) / Might you have a personal support vehicle? (Yes) (No)
Name of specified hotel roommate? (if any): / Stampede (1000K) or (1200K)
Name of Travel Partner, Specific Rider or Group Name for Lottery only:
If you have a preferred roommate, please list their name. No preference will be assigned a roommate based on arrival time each night (males with males, females with females). Specific Person or Group Name refers to folks whom you would not want to participate without. You will placed on the wait list until all applications are received

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/ ITEM AND COST (D.O.=Double Occupancy/2 riders per 2-bed room & S.O.=Single Occupancy/1 rider per room) / AMOUNT
Option #1 – D.O. hotel room for 3 overnights on route during event $500 / $
Option #2 – D.O. hotel room for 3 nights during event, 1 D.O. night pre-event & 1 D.O. night post-event $600 / $
Option #3 – D.O. hotel room for 3 nights during event, S.O. 1 night pre-event & S.O. 1 night post-event $700 / $
Option #4 – S.O. hotel room for 3 nights during event, 1 night pre-event & 1 night post event $900 / $
Lone Star Randonneur’s Membership which covers insurance (required & good for 50+ 2016 LSR events) $25 / $
Clothing**-All clothing is very high quality from Canari without any price mark-up. No re-orders will be made.
Jersey Size: (Men’s or Women’s) (Euro or Club cut) (XS, S, M, L, XL, XXL or XXXL) (circle one of each) $54 / $
XRT Gravity Short Size: (Men’s or Women’s) (XS, S, M, L, XL, XXL or XXXL) (circle one of each) $79 / $
CB Short Size: (Men’s or Women’s) (XS, S, M, L, XL, XXL or XXXL) (circle one of each) $63 / $
Arm Warmers Size: (XS, S, M, L, XL, XXL, XXXL) (circle one) $24 / $
Sun Sleeves Size: (XS, S, M, L, XL, XXL, XXXL) (circle one) $24 / $
Cycling Cap Size: (S/M or L/XL) (circle one) $25 / $
Winter Head Band One size only $16 / $
Shipping for clothing if you are not attending the event (per USPS small flat rate box) $10
TOTAL: / $
*Base price includes hot breakfast at each hotel, dinners at each of 3 overnights and 1 finisher’s dinner, a custom 3” x 4” finisher’s medal with neck ribbon, bike box storage during event, one drop bag to be shuttled to 3 overnights. We will strive to accommodate everyone who wants to ride, but we will be limited by our smallest hotel. All applications received between January 1 and January 15, 2016 will be placed into a lottery if entries exceed space available. Applicants or groups who are not drawn will be put on a waiting list. Ride starts May 11 rain or shine. We reserve the right to change or cancel the event due to circumstances beyond our control that arise without liability.
Mail application along with a check in the full amount payable to Tejas Sports with a signed copy of the liability waiver to:
Lone Star Randonneurs
c/o Dan Driscoll
2811 Hollywood Drive
Arlington, TX 76013
**Visit http://www.canari.com/custom/sizing for jersey sizes.
Euro cut is slimmer fitting and Club cut is looser fitting. / Refund Policy:
Cancel by 2/11/16 (3 months prior) receive a 80% refund
Cancel by 3/11/16 (2 months prior) receive a 50% refund
Cancel by 4/11/16 (1 month prior) receive a 20% refund
Lone Star Randonneur’s Membership and Jerseys
are non-refundable.
One application per rider.
Signature of applicant: / Date: