Benefit Ride Registration Form

BENEFIT RIDE REGISTRATION FORM

Sponsored by: BPOELogo MonkeyboneLogo EBBLogo

Event date: Saturday, October 27^th, 2018

Place: Elks Lodge, 7201 Congress Street, NPR FL 34653

Registration: 9:00 am -10:30/ Kickstart Mystery Ride @ 10:30

Food Bands included at registration

***THIS IS A RAIN OR SHINE EVENT!!***

Motorcyclist Name:(required)

Name of Passenger (if any):

Address:

Phone # (s):

City

State:

Zip:

E-mail address:

** I accept full responsibility for the motorcycle I have entered **(required)

Motorcyclist/ Owner signature(required)

** Liability Waiver: I hereby release and agree to hold harmless Red Apple Adult Training Center, as well as the directors, sponsors, representatives, agents, volunteers, and employees of any and all liability, loss, claims, and demands that may occur from any loss, from, or arising in connection with this event, and whether arising while engaged in competition or practice or preparation thereof, or while upon entering or departing from said premises or while participating or assisting in the event, voluntarily and in reliance, upon my own judgment and ability, and I hereby assume all risks for loss, damage, and/or injury (including death of myself or to my property ) from any cause whatsoever.(required)

Motorcyclist Signature(required)

Date of Motorcyclist Signature(required)

Passenger Signature

Date of Passenger Signature

Other Signature

Date of Other Signature

Motorcyclist Fee ($10.00) Passenger Fee ($5.00) All Others ($10.00)

To pay the registration fees click here:

We appreciate all of your support!

CH9235

A copy of the official registration and financial information may be obtained from the Division of Consumer Services by calling Toll-Free within the state. Registration does not imply endorsement, approval, or recommendation by the State.
Division of Consumer Service: 1-800-HELP-FLA (435-7352)
Website: www.FloridaConsumerHelp.com