Rider Entry Form

Rider Name:________________________________   Rider Age:_______   Gender:_______

Address:__________________________  City, State, Zip:__________________________

Phone: (daytime)________________________Phone:(evening)________________________

Email:___________________________________________________________________

Hotel Room Assignments:

Cycle for Sight will provide room and board during the ride based on double occupancy.  If you prefer single occupancy, or would like to share room with a non-rider (spouse, friend, etc.), you will be responsible for the difference in room rates.

Roommate Preference (please circle): Yes        No       Prefer Single

If Yes, whom?:______________________

Fundraising Promise:

Riders are asked to materially contribute to Cycle For Sight’s and the Institute for Families of Blind Children’s mission by raising or donating a minimum of $1,000. The $100 entry fee counts toward your fundraising total.  All funds raised or donated are due in to Cycle for Sight by June 15, 2008 for riders to participate in Cycle for Sight.

Entry Fee, Donation and Pledge Disclosure:

The $100 entry fee, as well as money raised by each rider and contributed to Cycle for Sight are non-refundable.  100% of funds raised after expenses goes to the Institute for Families of Blind Children, a registered 501(c)(3) organization.

I have read the above statements and wish to enter as a rider in Cycle for Sight 2008:

________________________           
Print Name:                                                  

________________________            _____________
Signature                                        Date

Checkout:

Registration Fee: --------------------------------------------------------------------------------------    $100.00­­__

Cycle for Sight 2007 Jersey: ($65)------------------------------------------------------------------  $_______

Male Sizes:   ___Small       ____Med    ____Large    ____XL   ____XXL

Female Sizes:   ___Small       ____Med    ____Large    ____XL   ____XXL

Additional Contribution:-------------------------------------------------------------------------------- $_______

                                                                                   Total:  $_______

Please make checks payable to:   Cycle for Sight

Mail checks and registration form to:     Cycle for Sight

                                                       P.O. Box 30613

                                                      Albuquerque, NM 87190-0613