Paris to Ancaster Entry Form

You can submit your entry for the 1999 Paris to Ancaster event via e-mail by filling out the form below and paying with a Visa credit card. You have 3 options:

1. Fill out the entire form, including Visa #, Expiry Date and Name on Card, and then submit the entry to us by e-mail (click on the Send button). Note: This is NOT a secure server transaction.

2. Print the form off, fill it out (including Visa information) and fax it to (519) 442-5259.

3. Fill out the form online without the Visa information, e-mail it (click on the Send button), and then telephone us with your Visa information. The telephone number is (519) 442-7905. You can telephone between 9:00 am and 8:00 pm

You will be required to either sign a waiver form, pay for day-of insurance, or show proof of OCA membership at the sign-in.


Name:

Club/Team:

Address:

Telephone:

OCA Member?
Yes
No

 Gender
Male
Female

 Event Entered:
Paris-Ancaster (60 km) - $30 (includes t-shirt if received before April 7th)
Tour of Ancaster (15 km) - $15 ($10 for ages 12 and under)

I need a ride back to Paris - $5

Total Amount: $

Visa Card Number:
Expiry Date:
(mm/yy)
Cardholder Name:
(as printed on card)

Multiple Entries: Please charge the following additional entries to my Visa. An entry form has been filled out for each person.