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2025 Blue Ridge Brutal Registration Form
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Categories
Rider Registration Fee -
$95.00
Participant Information
Contact Email
*
Participant First Name
*
Participant Last Name
*
Participant Birthdate
*
- month -
Jan
Feb
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- year -
2025
2024
2023
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1928
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1925
1924
1923
1922
1921
1920
Participant Gender
*
Female
Male
Country
*
-- select country --
Canada
International
United States
Street Address (w/Apt#)
*
City
*
State
*
-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-- select province --
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Zip Code
*
Phone
*
Would you like to
receive important event text alerts
on this number (eg. changes or delays)?
Emergency Contact
*
Emergency Phone
*
Select the size of your free t-shirt.
*
-- select one --
S
M
L
XL
XXL
Unisex
Affiliated Club, Team, or Organization
-- select your club or team --
- I am not a member of a team -
0530
3R
3T
40K Cycles
Aiken Bicycle Club
Backstreet 1RC Racing
Benissimo Cycling
Beverly Court Athletic Club
Bicycle Sport
Blue Ridge Bike Club
Boone Area Cyclists
C4 - Central Carolina Cycling Club
CanDoCurries
Cannonballs Cycling Team
Cape Fear Cyclist
Cape Fear Cyclists CFC
Capital Cycling Club
Carolina Cycling Team (CCT)
Carolina Masters Cycling
Carolina Tarwheels
CCC
Chain Reaction Cycling
Clemmons Bicycle
CRCA/NYCC Racing p/b Magen Financial
Cross Creek Cycling Club
Crosstown Velo p/b Hunter Subaru
CyclePath
Cycling Fanatics
Defeet
E3 Endurance
EFRT
EFT
Eliel Factory Team
EVOQ.BIKE
Extreme Networks
Fainting Goat Cycling Club
Fellowship of Christian Athletes
Fellowship of Christian Athletes Club
Fillnow Coaching
First Flight Bikes
Flow Formulas Racing
Foshee Racing
Greensboro Velo Club
Gruppetto
Gyros
Henderson Custom Homes
Hickory Velo Club
High Country Racing
Jigawatt Cycling
Joes body shop
KABC
Kennedy Law Racing
Killer Cadence Spoke Busters
Lonerider
Mack Trucks
Malone Coaching
Mid Carolina Multisport
Monkeybutt
NC LCC
NCARS
NICH +SpeedClub
Piedmont Flyers
PPTC
Queens University Triathlon
Rage Cage
Red Star Racing
Revolution Cycle Sports p/b Lonerider
Revolution Cycles NC
Rhoddie Bicycle Outfitters
Richard Head Racing
Rock Hill Bicycle Club
Rocket Coffee Company
Rocket Revolution
Rocky River Road Club
S3 Multisport Performance Team
S3 Multisport Racing Team
Saddleblock
Salty Turtle Cycling Club
SLICES OF HEAVEN CC
STBC
Stonebridge Cabin dwellers
Stonebridge cabin dwellers
Tarwheels
Team 0530
Team ADL
Team CBC
Team Gruppetto
Team Mg12/ Relyte Electrolytes
Team SOTR
Team Steve Cope
Team Tradd
The Bike Gallery
The Velo Collective
The Weekend Warriors
TORC
Triangle Velo
Trimarni Team
Tristacey coaching
US Military Endurance Sports
Velobrew Racing
Velocious Sport
Velocity Cycling CLT
VeloPigs
Working Triathlete
Zoom Multisport
add new team
new team name
Which ride distance
*
-- select one --
25 miles
50 miles
70 miles
100 miles
Are you riding an E-Bike?
*
Yes
No
I understand that my registration fee is NONREFUNDABLE. In the event that you don't participate the proceeds from your registration will be given to our charity partner.
*
Make a Donation
Ashe Advantage Project
Amount $
Ashe County Advantage Project, a 501(c)3 non-profit, is collecting donations to support small business recovery efforts in the wake of Hurricane Helene's severe damage to the region. All funds will be distributed locally to support small businesses recovering in Ashe County.
Waiver
*
I have read and agreed to the TERMS
*
CLICK HERE TO VIEW THE TERMS
.
Is the participant 18 or older?
*
18 or older
Under 18
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian.
If registering a child under 18, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
Parent's signature
Payment Details
Discount or Tracking Code
Apply
Do not COPY & PASTE the code, please type it into this field.
Price
$
Discount (-)
$
Total
no handling
$
Handling
$
Donation
$
Total Owed
$
Payment Method
The payment and credit card section is not visible because there is nothing owed or form fields have not been fully completed.
Visa
Mastercard
Amex Card
Payable To:
Address:
click the "submit" button to submit your order then send a check to (or pay in person at) the address above.
1. Venmo the total amount to the Phone #:
2. Make sure you enter the code,
70266
in "What's it for".
3. Click the "pay now" button.
Enter a Check Number
Enter a Check Amount
Send email receipt to the participant
Send email receipt to the participant
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