Please Select One
Driver - $75
Motorcycle - $50
Sponsor - ANY AMOUNT
Volunteer - FREE
Additional persons attending - $10
Broker - $50
Donation - ANY AMOUNT
Non-Driver - $50
Support Driver - $75
First Name:
*
Last Name:
*
Address:
*
City:
*
State:
*
Zip:
*
Phone (Home):
Phone (Cell):
Email:
*
Trucking Co.:
Truck #:
T-Shirt Size(s):
The Organization, staff and volunteers discharge themselves of all liabilities related to any incidents or damages that may occur during the Convoy for a Cure - USA event and all related activities.
Absolutely no drugs or alcohol will be tolerated for this event.
I have read and I accept these conditions.
Signature:
*
All registrations must be received by Sept. 15, 2010. Remit to: Convoy for a Cure - USA 1204 VZCR 3832 Wills Point, TX 75169