Tour of the Ozarks Mail-in Registration

First Name:________________Last Name:__________________

Address:______________________________________________

City:________________ State:_____ Zip:__________

Email:________________________________

Day Phone:____-____-________ Evening Phone:____-____-________

Gender:________________ Birth Date:____/______/______

Category (circle one): Individual Tandem Team (at least four members)

Name of Tandem Partner:________________________________

Team Name:________________ (Tandem or Team Name)

Team Leader:________________ (Tandem or Team Leader Name)

Donation:________________

Emergency Contact:________________________________

Emergency Contact Phone:________________

Route (circle one): 12 25 50 100

Brief Explanation of any Special Medical Conditions: ____________________________

T-Shirt Size:________________

Return form and a check to:

Tour of the Ozarks
11546 Timberline Drive
Rolla, MO 65401