REGISTRATION FORM

Rider _________________________________________  Phone No. ________________

Address ________________________________________________________________

Passenger _____________________________________  Phone No. ________________

Address ________________________________________________________________

Cost per person:
     Saturday - Ride & Events:  $15.00  No. of attendees _____ x $15.00 = _____________
     Sunday - Pow Wow:          $  5.00  No. of attendees _____ x $  5.00 =  _____________

____ Pin  ____ Patch $4.00 ea. or ____ Combo for $7.00

T-shirt:  ___ Small  ___ Medium  ___ Large  ___ X-Large  ___ XX-Large  ___ XXX-Large

Tank Top:  ____Medium  ____Large  ____X-Large

Scarf - $5.00 each:   ____ Black  ____ White  ____ Red  ____ Grey

Hats - $5.00 each:  ____ Black/Turquoise  ____ Black/Yellow  ____ Black/Orange
                              ____ Gray/Red            ____ Black Mesh     ____ Gray Mesh

I understand by signing this form, that I am responsible for my own actions and agree to act in an orderly manner. I also agree that I, my heirs, administrators and/or assigns will not hold the organizers of this run and/or owner of the grounds liable for any damages, accident and/or injury incurred in connection with this event.

______________________________   ______________________________   ________                    Rider's Signature                                  Passenger's Signature                    Date

Please return completed form with payment in full, made payable to St. Joe's Indian School Run, to 8404 Jonestown Road, Grantville, PA 17028. If you are unable to return this form in advance, please bring it COMPLETED to assist in processing. Thank you for your cooperation.

                                                                         Total Amount Enclosed $_______________