* Gender:

* Birth date (mm/dd/yyyy) Solely for record purposes and will not be disclosed to anyone.

* Please select your ride distance. You aren't tied in to this choice and can change your mind since all courses are the same price.

Employer's Name:

* Please select your t-shirt style: (Fitted or Unisex/Relaxed Fit options available)

* Please select your requested t-shirt size and style, and remember - for the fitted version, be sure to size up.

* Packet pick-up will be held from Friday, September 20th thru Monday September 23rd. Keep in mind that you'll need to fundraise your $75 by September 13th in order to pick your packet up in advance of the ride:

* Please select your food preference below. We'll have food trucks at the event; your food preference will be used for their planning purposes:

Would you like to buy extra lunch tickets? Extra Lunch Tickets are $10.00 each. Quantity:

* Want key cycling tips, inspiration and chances to win gear? Sign up for the monthly Trek Women News - trust us, you'll want to hear what they have to say.

* Emergency Contact Name:

* Emergency Contact Phone Number:

How did you hear about Venus de Miles?

What is your annual household income? This is helpful for our research and is strictly confidential. We take your privacy very seriously.

* Would you like to receive a one-month complimentary training plan for Venus de Miles from FasCat Coaching? It will be accessible via a one-month complimentary Training Peaks website. They are offering beginner, intermediate and advanced training plans are among the best in the business! After the first month, they will be offering a great Venus discount on their coaching packages, so you can take it to the next level!

* How did you hear about Venus de Miles? If it was from a friend that is already signed up to ride, please list their name so we know who to thank.

* On September 29th, please sign me up for (check all that apply):