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 a 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.

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:

________________________    
Print Name:

________________________            _____________
Signature                                                      Date

Checkout:

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

Cycle for Sight 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 forms to:
Cycle for Sight
P.O. Box 30613
Albuquerque, NM 87190