2009 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' 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 12, 2009.

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, a registered 501(c)(3) organization.

I have read the above statements and wish to enter as a rider in Cycle for Sight 2009:

________________________           
Print Name:                                                  

________________________            _____________
Signature                                        Date

Checkout:

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

Cycle for Sight 2009 Jersey: (Free)-----------------------------------------------------------------  $0
___Small       ____Med    ____Large    ____XL   ____XXL

Extra Cycle for Sight 2009 Jersey: ($65)----------------------------------------------------------  $_______
___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