Registration | AIDS Ride for Life

Rider Registration

9/9/2017

About you
First Name
Last Name
Email
Date of Birth
* You cannot register online because you will be under 14 years old on the day of the ride. Please email crotella@stapinc.org if you have any questions.
Gender MFT
Existing Medical Conditions? YesNo
List of Conditions
Contact Info
Phone Number
Street
Apt / Suite
City
State
ZIP Code
Accompanying Adult Rider
Full Name
Date of Birth
Email
Phone Number
Emergency Contact
* Your emergency contact cannot be another rider.
Full Name
Relationship
Phone Number
About the Event
Miles you will ride 14254290102Indoor
Are you in a team? YesNo
Team Name
Are you the team captain? YesNo
Accept T-Shirt and gifts? YesNo
T-Shirt Size
Are you a first time rider in the Ride? YesNo
How many times have you ridden prior?
Will you be attending 6pm dinner at Stewart Park? YesNo
* You and one guest are included in your registration fee. Additional guests are $8.00 each (pay at dinner).
Total number of dinner guests including yourself
Other
How did you hear about the ride?
Training Notify me of about training rides.
ARFL Sign I would like to display an ARFL sign for my yard.
Sponsorships I would like to learn more about Sponsorship Opportunities.
Other Events I would like to receive information about other STAP events.
Registration Fee & Fundraising
Fundraising In addition to the registration fee, I understand there is a minimum $300 fundraising requirement. In addition to the registration fee, I understand there is a minimum $100 fundraising requirement. 100 In addition to the registration fee, I understand there is a minimum $100 fundraising requirement. 100
Registration Fee $ 45 25 25
Discount Code YesNo
Waiver I have read and agreed to the rider waiver.
You had errors on your form. Please fix them and re-submit. A confirmation e-mail will be sent to you after you have paid the registration fee.

Registration Fee

We use PayPal to accept payments. You will receive a confirmation email once the PayPal payment is confirmed.

Rider Registration

About you

Contact Info

Accompanying Adult Rider

Emergency Contact

About the Event

Other

Registration Fee & Fundraising

Registration Fee