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Pre-Registration for "Ride Like an Animal" Motorcycle Ride
October 2, 2010 at 10 am.

*Pre-Registration Form for 1 Bike with or without passenger. To register for the Motorcycle Run, please complete the fields below.

Rider's Full Name:

Address:

City:      State:      Zip:

Phone Number(s): (Please include area code)

Email:


Passenger's Full Name:

Address:

City:      State:      Zip:

Phone Number(s): (Please include area code)

Email:


$20.00 - 1 Rider includes T-Shirt:

$30.00 - 1 Rider & Passenger includes 2 T-Shirts:

Please indicate your T-Shirt size(s) in the T-Shirt Order Section below.

 


Unlimited T-Shirt Order

Please include number of each size. T-Shirts will be $18 - $20 at the gate while supplies last. Purchase NOW to ensure that you get one!

Adult SM (each additional T-Shirt - $15):      

Adult MED (each additional T-Shirt - $15):      

Adult LG (each additional T-Shirt - $15):      

Adult XLG (each additional T-Shirt - $15):      

Adult XXLARGE (each additional T-Shirt - $18):

Adult XXXLARGE (each additional T-Shirt - $18):


Make a tax deductible donation to the Union County Humane Society $

Payment Method:
Personal Check - Check #
  Money Order - MO#

Total Payment Included: $

Union County Humane Society is not responsible for any damages, accidents or physical harm to riders, passengers, motorcycle or any other personal property that might occur during this event.

You will have to sign a liability waiver on the day of the event.

Please press submit when you are finished. Thank you for your support.