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2015 Ride Application

Highlight this form, print it and mail

"Ride for the Relay 2015"
September 5, 2015
"10th Anniversary"
Participant Application 2015 

Starting Point: _________________ Ending Point: _______________

Name: ___________________________________________________

Corporation: ______________________________________________

Address: _________________________________________________

City/State/Zip: _____________________________________________

Telephone: ___________________ Alt: _________________________

eMail address: _____________________________________________

Corporate Sponsor: (      )  $660
            Pin Sponsor: (      )  $330
Non-Rider Gold Sponsor: (      )  $132         
Non-Rider Silver Sponsor: (      )  $66           
Non-Rider Bronze Sponsor: (      )  $  33             

Rider Package:  (      )  $132 ------ T-Shirt Size:  S   M   L   XL   XXL   XXXL
Passenger Package:  (      )  $132 ------ T-Shirt Size:  S   M   L   XL   XXL   XXXL


Riders Package includes:  T-Shirt, Patch, Pin, Cap, Windshield Decal,
5 Raffle Tickets, ATWG Plaque and first time ATWG Patch.

Passenger Package includes.  T-Shirt, Patch, Pin, Cap, 10 Raffle Tickets, 
ATWG Plaque and first time ATWG Patch.

Send all 2015 Participant Applications to:
Ride for the Relay 2015
C/O Rodger L. Fox
63 East Central Park Plaza
Jacksonville, Illinois 62650

Make all checks payable to Ride for the Relay or the American Cancer Society
Call 217-473-1525 if you have any questions.


         
 
         

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