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The Psycho 48 begins and ends at a rural headquarters on Seawell Loop in Bayboro, North Carolina. Soybean fields surround the location, with few houses visible. This grass-roots ultra-cycling event takes place in October, offering distances from 100 miles to 12, 24, or 48 hours on the bike. The 48-hour riders begin on Friday, while other formats start on Saturday. This allows the longest-distance riders to finish with the 24-hour participants.
The course is a 35-mile loop on flat, smooth, quiet roads in Eastern North Carolina. It is ridden clockwise, featuring mostly right turns and only three left turns that require attention. Riders complete the loop multiple times based on their chosen distance, suitable for a first century, a substantial training block, or a Race Across America qualifying attempt. Participants come from across the country, joining local riders. The event originated from a riding group that humorously referred to each other as “psycho.” Carol Beliveau, an organizer and veteran ultra-cyclist known as “Queen Psycho,” significantly shapes the race's character.