2006 Printable Pre-Registration Form
Mail completed form with check or money order made payable to
" BRAVE Riders"
before May 26 2006 to:
BRAVE Riders
Post Office Box 393
Aliquippa PA 15001
□Motorcycle □ Classic Cars
□ First Year □ New Address
| Name: | Pre-Registration - Rider $15.00 (includes 1 meal tic.) |
| Address: | Pre-Registration - Passenger $10.00 (includes 1 meal tic.) |
| Classic Car - Per Vehicle $15.00 (includes 1 meal tic.) | |
| x-tra Meal Ticket #_______X $ 5.00 ea. | |
| Total meal tickets $ .00 | |
| Passenger Name: | Total Registration: $ .00 |
| Address: | Total Sponsorship: $ . |
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If Total Sponsorship is $100 or more, no registration fee is needed! (Only one free T-shirt & Patch or Dash Plaque and meal Ticket per entry) |
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| Total Amount of Remittance: $ . | |
| Email Address: | |
| I / we will ride "In Memory Of ..." | |
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I / We, the undersigned, release from liability BRAVE Riders, its committee, its staff and volunteers, Geneva College, CCBC, COPS Inc., the officers and members and any other parties or municipalities assisting us, either directly or indirectly. Moreover, hold harmless and free from any liability resulting from my / our participation in this event. Being of sound mind and capable of behaving in a responsible manner, I / we accept full responsibility for any consequences resulting thereof. |
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| Telephone Number: | Signed: |
SPONSORS
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Bonus Offer! Raise $100 or more in donations and receive commemorative items. (Dash Plaque for Classic Car Reg) and ride FREE!! Simply add the name and address of each sponsor in the area provided and return by mail by May 26, 2006 |
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