2004 WCRC Bus To Quebec City

Friday, August 27 to Monday, August 30, 2004

Please prepare a separate application for each person taking the bus.

First Name: [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
Last Name: [ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ][ ]
Event: Marathon [ ]  Half-Marathon [ ]  10K [ ]  Spectator [ ]
Enclosed:  $100.00 for WCRC or CAA members or their guests [ ]
SEX: [ ]       AGE: [ ][ ]  must be 18 years or older     

Street Address _______________________________________________

Town:_________________________  State:________   ZIP:__________

Telephone:___________________  E-Mail:_______________________

Since this is an international voyage, everyone on the bus must bring a valid  passport or driver's license. Please provide the following information exactly as it appears on your legal ID:

Full Legal Name ______________________________________________   

Street Address _______________________________________________

Town:_________________________  State:________   ZIP:__________

*** Place of Birth ***                                    Date Of Birth: ______________

Town:_________________________  State:________   Country:__________

Checks payable to: Winner's Circle Running Club. Mail To: Vicki Miller, 143 Durham Point Road, Durham, NH 03824. For more information call Vicki at (603) 868-7203 or e-mail at vickim@xenia.unh.edu.