Pediatric Cancer Treatment Foundation

2nd Annual  Pediatric Cancer Ride Pre-Registration
When- Sunday, July 23rd 2023    Where- Harley-Davidson of Asheville, Asheville NC

Registration opens @ 9 AM.

All mailed registrations must be received by June 30th, 2023

Rider Information

Name-      __________________________________________________________________
Address-__________________________________________________________________
Phone-__________________________________________________________________
E-mail-__________________________________________________________________

Passenger Information*
Name-      __________________________________________________________________ 
Address-__________________________________________________________________
Phone-__________________________________________________________________
E-mail-__________________________________________________________________

 Event Cost-  The cost per rider is $35.00;  + $15.00 per passenger

 Event t-shirt-  $40.00 per t-shirt

Size & Quantity: (write in the number of shirts desired next to the size)
Select Men’s ______ 
 ____Small____Medium____Large____X-Large____2X-Large___3X-Large
Select Woman’s_____
____Small____Medium____Large____X-Large____2X-Large___3X-Large

Registration Instructions:
Add your registration fee ($35.00), plus $15.00 if you have a passenger.
Then add $40.00 for every t-shirt ordered.  Add it all up and sent that amount

Payment Instructions:
1)      By Check- Please send check payable to PCTF and your registration to P.O. Box 1460, Murphy, NC 28906 (in memo-PCTF RIDE).
2)      By Credit Card- please e-mail the attached credit card authorization form to rtrigueros.pctf@att.net. (please note there is a 3% fee for credit card payments).

3)      By Pay Pal on-line- Go to the website's HOME page and click on DONATE.  Please reference 'PCTF Ride Registration'

Payment:  Check______________   Credit Card________ On Line: __________

 

PCTF Only:   Received on ________________________  Received by______________________

                                     Confirmed On _____________________________

Let’s put

an end to Cancer

world-wide!