EmailMe Form - FlashCut 20 or 10 mile Bike to Work for ELH

Name *

First Last

Email *

Cell Phone *

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Emergency Contact Name

First Last

Emergency Contact Phone

### - ### - ####

Donation amount

$ Dollars . Cents

Payment Options

Paypal

Check by mail

Check or cash on day of ride

100% of all payments will go directly to Erika's Lighthouse. If paying by check please fil out, print and submit this form and either mail it with your donation to ELH at the address below or bring a check with you to the event.

Erika's Lighthouse
PO Box 616
Winnetka, IL 60093

If paying by Paypal, please fill out this form and submit it then go to this web address to make the donation online:

http://www.erikaslighthouse.org/Events/flashcut.html

Shirt Size

Small

Medium

Large

XL

XXL

I don't want a shirt

All riders who donate $50 or more will get a T-shirt. Please fill this out before 6/27 to ensure receiving a shirt and getting the proper shirt size. Otherwise, we will guess for you.

Ride Preference

20 mile route

10 mile route

I am not riding

I am not riding but I would like to sponsor:

First Last

Please put the person's name that you are sponsoring or leave blank if it is in your name.

Release of Liability *

By checking this box I agree and understand that bicycle riding is inherently dangerous and I assume all risk and neither FlashCut CNC nor Erika's Lighthouse is responsible for any accident or injury that may occur.

I am not riding in the event.

Comments

Thank you for participating. We look forward to seeing you on July 11th!

Remember to PRINT the completed form before hitting the submit button!