2011 CIBA Awards application

(11/1/10 to 10/31/11)

Must be RECEIVED by November 12, 2011

 

Name:______________________________________ Phone:_____________________________

E-Mail:_____________________________________ Age:  over 55 Male / Female

Address:___________________________________________________________________________

(Please print clearly)

 

For details on the award program, please look on the website under “CIBA / Awards.” Please attach mileage logs and volunteer hour logs with this form. Pictures of all artwork and items are also on the website.

 

Rider Mileage – Millennium award if over 1,000 total miles ridden

CIBA Miles _______                     Mileage Certificate

Commuter Miles _______

Other Miles _______                    Drawstring Bag – Circle Color:          Black            Hot Pink

                                                                                                                                                                             Royal          Red         Navy

Total Miles _______                                                                                   

 

Double Millennium

Purchase Double Millennium short sleeve tee shirt (riding over 2,000 miles total)

Circle tee shirt size:     S    M    L    XL    XXL    XXXL

(Please include a check for $15, payable to CIBA)

 

Commuter

Commuter tee shirt (1,000 or more commuter miles). Also select a level 1 incentive on the reverse side.

Circle tee shirt size:    S     M     L     XL     XXL     XXXL

Commuter award (over 500 miles): Select one level 1 incentive on reverse side.

 

CIBA Star S/S Jersey – 2 ways to earn it!

1. CIBA Star Multi-Tasker (must complete all 5)

             ____ 600 or more CIBA miles _____15 or more volunteer hours _____Ride Leader

             _____ 100 or more commuter miles _____mentor 2 or more times.

 

2. Host 2 traditional, fully sagged and marked week end rides

 

Jersey made by VOMax (Circle one)

Unisex Sizing:   S(36-38)     M(38-39)     L(40-41)     XL(42-43)     XXL(44-45)     XXXL(46-47)

 

Volunteer

Total Volunteer Hours ___________ (do not include ride leader hours if compensated with a Ride Leader incentive)

Volunteer Certificate: Yes No

If this total is 50 hours or greater, select one level 1 incentives on reverse side.

If this total is 100 hours or greater, select either a Stormtech jacket with CIBA logo below or select two (2) level 2 incentives on reverse side.

 

Circle Color:     Black     Navy     Red

 Circle Size:     Small     Medium     Large     X-Large     XX-Large     XXX-Large

 

Pinnacle

Pinnacle Award Trophy: Fill out award form on the website under documents and forms and attach.

 

Ride Leader

If you have not received your ride leader incentive, please fill out the Ride Leader Incentive Application and send it in. The form can be located on the website under “CIBA / Awards”.

Incentives

 

Incentives will be available at the annual meeting in January and at the Swap Meet in February. Please check off as many items that are applicable if you earned more than 1 award! Pictures are on the website under “CIBA / Awards”.

 

Level 1 Incentive Choices:

Park Tool Folding Hex Set Bike Tool       Portfolio with CIBA Logo

  Folding Duffle Bag with CIBA Logo        Polar insulated 24 oz water bottle with the CIBA logo.

  Arm warmers with CIBA Logo – Circle Size:     Large     X-Large

  Blanket with the CIBA logo – Circle Color:     Red     Royal     Navy

(Not pictured on Web Site)

 

Selection of one of the following books:

Chris Carmichael’s Food for Fitness

  Bicycling Magazine’s Complete Book of Road Cycling Skills

  The Cyclist’s Training Bible by Joe Friel

  Weight Training for Cyclist by Ken Doyle and Eric Schmitz

 

Level 2 Incentive Choices:

 

Men’s long sleeve Augusta Sportswear tri-color heavyweight brushed tricot sports jacket with CIBA logo:

(circle color and size choice)

Black/Gold/White:                    S         M          L          XL          2XL      3XL

Navy/Silver Grey/White:          S         M          L          XL          2XL      3XL

Red/Black/White:                     S        M          L          XL          2XL      3XL

 

Women’s long sleeve Augusta Sportswear tri-color heavyweight brushed tricot sports jacket with CIBA logo:

(circle color and size choice )

Black/Gold/White:                    S        M          L            XL          2XL

Navy/Silver Grey/White:          S        M          L            XL          2XL

Red/Black/White:                     S        M          L            XL          2XL

 

Unisex Dunbrooke Relay Jacket – wind and water resistant polyester shell with CIBA logo:

(circle color and size choice)

Navy:         S       M      L     XL    2XL    3XL

Red:          S       M      L     XL    2XL    3XL

Royal:       S       M      L     XL    2XL    3XL

 

Yellow helmet cover embroidered with CIBA logo

 

Blackburn MARS 3.0 Rear Light

 

 

Form MUST BE RECEIVED by November 12, 2011 – send to:

 

Sandy Lawson, 1289 W. 136^th St., Carmel, IN 46032.

Or email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it.

 

Please feel free to call (317) 679-9261 with questions.

 

FORMS MUST BE IN ON TIME OR YOUR AWARDS WILL NOT BE ORDERED!!!