3rd Annual Ride 4 Their Life Event Registration Form
Attendee Information
Please fill name and contact information of attendees.
Your Name
*
First Name
Last Name
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Will you have an additional rider with you?
Yes
No
Additional Rider Name
First Name
Last Name
Additional Rider Email
example@example.com
Additional Rider Contact Number
Please enter a valid phone number.
Would you like to receive updates about our organization?
Yes
No
Emergency Contact Person
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
A Liability Waiver will be filled out when you arrive at Registration.
Please make a selection(s):
*
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Rider Fee (After 4/11/2026)
This includes meal at cookout
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
Passenger Fee
This includes meal at cookout
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Cover Processing Fees
This takes the processing fees off us - we appreciate it!
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
*EARLY BIRD REGISTRATION* Rider Fee (Ends 4/11/2026)
This includes meal at cookout
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
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
XS
S
M
L
XL
XXL
XXXL
Credit Card
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