2010 Torch Ride registration Survey

*
1. Please enter your contact information.

Please enter your contact information. Name:
Work Address:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

*
2. What is your t-shirt size? (Check one)

What is your t-shirt size? (Check one) Small

Medium

Large

X-Large

2X-Large

3X-Large

3. Please enter your birthdate. (Optional)

	MM		DD		YYYY
Birthdate	Please enter your birthdate. (Optional) Birthdate Month	/	Day	/	Year

4. Please enter your gender. (Optional)

Please enter your gender. (Optional) Male

Female

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5. I understand that the Special Olympics State Office must receive my $35 registration fee per motorcycle/$15 additional rider by September 10th to receive the free raffle ticket and free souvenir t-shirt.

I understand that the Special Olympics State Office must receive my $35 registration fee per motorcycle/$15 additional rider by September 10th to receive the free raffle ticket and free souvenir t-shirt. I agree

Thank you for completing the Torch Ride to benefit Special Olympics Indiana online registration.

The top fundraiser at pre-registration will be the lead rider for the Torch Ride. If you would like to use our fundraising Web site, visit www.firstgiving.com/soindiana.

Please make checks payable to: Special Olympics Indiana, Attention: Torch Ride, 6100 West 96th Street, Suite 270, Indianapolis, IN 46278.

Thank you for your support of Special Olympics Indiana and the Law Enforcement Torch Run.

2010 Torch Ride registration
Exit this survey >>

1. Contact Information & Background

*
1. Please enter your contact information.

*
2. What is your t-shirt size? (Check one)

3. Please enter your birthdate. (Optional)

4. Please enter your gender. (Optional)

*
5. I understand that the Special Olympics State Office must receive my $35 registration fee per motorcycle/$15 additional rider by September 10th to receive the free raffle ticket and free souvenir t-shirt.

2010 Torch Ride registrationExit this survey >>

1. Contact Information & Background

*1. Please enter your contact information.

*2. What is your t-shirt size? (Check one)

3. Please enter your birthdate. (Optional)

4. Please enter your gender. (Optional)

*5. I understand that the Special Olympics State Office must receive my $35 registration fee per motorcycle/$15 additional rider by September 10th to receive the free raffle ticket and free souvenir t-shirt.

2010 Torch Ride registration
Exit this survey >>

*
1. Please enter your contact information.

*
2. What is your t-shirt size? (Check one)

*
5. I understand that the Special Olympics State Office must receive my $35 registration fee per motorcycle/$15 additional rider by September 10th to receive the free raffle ticket and free souvenir t-shirt.