PLEASE PRINT AND COMPLETE!
The
Ice Cream Run is a Charity event where all the proceeds go to providing for
children with healthcare challenges, for pediatric wards in local hospitals,
and other children’s causes. Your
Registration Fee of $25 covers breakfast, ride, and t-shirt. Remember it’s all for the kids, so come have
fun and help us have a successful event again this year.
Registration is from 9:30 to
11:00 at the Hamden Town Hall July 26, 2008.
Name: ________________________________________ Address: ________________________________________________________________
Email: _______________________________________
Bike ____ Car
_____ Truck_____ Number of participants over 16
__________ X $ 25 = Registration Fee__________
Number
of participants under 16 _________ Free (no shirt or dinner) xxxxxxxxxx
License #_____________ (Must have minor release forms) Extra T-shirts x $15.00= ___________
Oversized Fee x $3.00= ___________
Total Participants _________ Total due : __________
# of T-shirt: _______S ______M _____ LG _____XL
(1 per paid participant) _____2X _____ 3X (please add $3 per shirt) (Make Checks payable to ICRC, Inc.)
I have read, understand, and
have signed and attached the release forms provided and will make sure myself
and all who ride with my vehicle will have all the proper registration fees
paid and release forms signed and submitted.
Signature:
_____________________________________________________ Date:
______________
Ice Cream Run Charities
P.O. Box
11 Hamden , NY
13782
Ice Cream Run Charities
2008 Registration