We-Bike-For-Kids

2013 Registration Form

Name_________________________________________________________________________

Address _______________________________________________________________________
City __________________________________ State _________Zip _______________________
Home phone __________________ E-mail ___________________________________________

I will ride the (must check one)

_____ 62 miles;

_____30 Mile Ride ;

_____10 Mile

Registration fee: $30 Day-of Event Registration: $35 Make checks payable to: We Bike For Kids
T-Shirt Size: _____ S, _____ M, _____ L, _____ XL, ______Mens or Womens
Emergency Contacts:
Name _______________________________________ Ph _________________________
Waiver: I hereby waive all claims against We Bike For Kids Administration and volunteers, sponsors,
suppliers or any other associated personnel for any injury to myself, or any loss, theft or damage to
property for this event. I attest that I am physically fit and prepared for this event. I grant full permission
for the organizers to use any photographs, likeness and/or quotations from me in accounts or promotions
of this event.
Riders are encouraged to solicit pledges from neighbors, family and friends.
Prizes will be awarded to three riders raising the highest pledge donations.

Signature __________________________________________________ Date________________

Return this form with payment and pledges to:
Visit Website for more information:
Howard T. Johnson
2224 Clearwater Run
www.webikeforkids.com
The Villages, FL 32162
Ph 352-751-0355