2016 REGISTRATION/CONTRIBUTION FORM
Motorcycle Ride / Classic Car Registration / Family Picnic
Faces Of Valor USA Fundraiser

June 26, 2016 - Sunday

Details on the 2016 Faces Of Valor USA Fundraiser and its 3 Events


Name:  
Address 1:  
Address 2:  
City:  
State:  
Zip:  
E-mail:  

TEE SHIRTS (indicate # of each size)
Free tee shirts to the first 500 event participants!

Qty Size
  Small
  Medium
  Large
  Extra Large
  2X
  3X

The form is self-calculating.
Enter your quantities and click "TOTAL".
Do not hit "Enter" or the form will submit prematurely.

FEE/CONTRIBUTION (indicate # of each)

Qty Motorcycle Ride (includes picnic) Total
Bike & Driver x $25 ($30 on 6/26)
Bike Passenger x $25
Qty Car Show (includes picnic) Total
Car & Driver $25 ($30 on 6/26)
Car Passenger x $25
Qty 5K Fun Run/Walk (includes picnic) Total
Runner x $25 ( $30 on 6/26)
Walker x $25 ($30 on 6/26)
Qty Family Picnic Total
Adult x $15 ( $20 on 6/26 )
Teen/Child x $10, ( $15 on 6/26 - under 5 free )
Optional/Additional Contribution (select one to help our injured, wounded, or killed local heroes)
Other Amount  
TOTAL

CREDIT CARD INFORMATION
This is a secure transaction
Visa     MC     Discover
Credit Card Number:  
Name on Card:  
Verification Code:   Where is it?
Expiration Date:  

100% tax deductible; all funds raised go to the Faces Of Valor USA mission.


WAIVER AND RELEASE OF LIABILITY, PUBLICITY RELEASE, AND INDEMNITY AGREEMENT

Accept Decline

Signature (type name)
Signature of Parent/Guardian (if under 18)

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