3rd Annual Ride 4 Their Life Event Registration

3rd Annual Ride 4 Their Life Event Registration Form
Attendee Information

Please fill name and contact information of attendees.
Your Name*

First NameLast Name
Email Address*
example@example.com
Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Will you have an additional rider with you?

YesNo
Additional Rider Name

First NameLast Name
Additional Rider Email
example@example.com
Additional Rider Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Would you like to receive updates about our organization?

YesNo
Emergency Contact Person

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
A Liability Waiver will be filled out when you arrive at Registration.

Please make a selection(s):*

Rider Fee

This includes meal at cookout

$30.00 Quantity

Passenger Fee

This includes meal at cookout

$10.00 Quantity

Cover Processing Fees

This takes the processing fees off us - we appreciate it!

$5.00 Quantity

Black T-Shirt with 'The DEMP Project RIDE 4 THEIR LIFE' graphic

All proceeds from t-shirt sales go directly to support survivors.

$15.00 Size

Total

$0.00

3rd Annual Ride 4 Their Life Event Registration Form