Ride for Wishes - Registration Form

Registration Form

This online registration accepts payment via
Solution Graphics

Driver:

Cost = $25.00 Pre-register by 5/30/2011 to receive one free t-shirt

First Name:

Last Name:

By checking this box, I certify that I will be 18 years old or older
on the date of the bike run, Saturday, June 04, 2011.
Note: Proof of age will be required on the day of the event.

Address:

Apt:

City:

State: Zip:

Phone:

( ) - Ext:

E-mail:

Passenger:

(Cost = $15.00)

First Name:

Last Name:

I would like to help the kids with an additional cash donation of: $

Select your free t-shirt for pre-registering by 5/30/2011

T-Shirt
Medium

T-Shirt
Large

T-Shirt
XL

T-Shirt
XXL

T-Shirt
XXXL

Ladies Tank Top Medium

Ladies Tank Top Large

Ladies Tank Top XL

Pre-order additional t-shirts now - Indicate quantity below each size

NOTE: On the day of the event, Saturday, June 04, 2011 , a limited supply of T-shirts will be available. Order now to guarantee that you get yours.

T-Shirt Medium $12.00/ea ($15.00 day of event)	T-Shirt Large $12.00/ea ($15.00 day of event)	T-Shirt XL $12.00/ea ($15.00 day of event)	T-Shirt XXL $12.00/ea ($15.00 day of event)

T-Shirt XXXL $12.00/ea ($15.00 day of event)	Ladies Tank Top Medium $12.00/ea ($15.00 day of event)	Ladies Tank Top Large $12.00/ea ($15.00 day of event)	Ladies Tank Top XL $12.00/ea ($15.00 day of event)

Sub-total :