Registration Form  Pigeon Lake Pedal Saturday, July 5, 2008

Registration includes long sleeve t-shirt, snacks & BBQ lunch.

One PRIZE draw ticket for each $100 collected by event.

Name:__________________________________________________________________
Address:________________________________________________________________     
City: ___________________________________Postal Code:______________________
Phone Number: ______________________Email:________________________________
Emergency Contact: _______________________________________________________
Alberta Health Care #:______________________________________________________
 
_______________ x $25 per person (If register before Sunday, June 22, 2008)
_______________ x $35 per person (registered after June 22, 2008)
$_______________TOTAL  Payment by Cheque _____Cash _____Credit Card ____

Credit Card Type_____ # ____________________

Expiry mo___ yr_____ Signature __________________________
PARTICIPANT WAIVER: In consideration of accepting this entry. I hereby, for myself, my heirs, executors and administrators, waive and release any and all right or claim to damages I may have against the organizers of this event, their agents, representatives, volunteers, successors and assigns, sponsors and the Alberta Cancer Foundation, for any and all injuries I may sustain during the course of this event. Children under 13 must be accompanied by an adult for 60 km long ride.

X________________________________ Signature of participant

(if participant is under 18 years of age, waiver must be signed by parent or guardian).

TO REGISTER:
    1. Complete and sign this Registration form.

    2. Pay Registration fee:

        a) CHEQUES payable to ALBERTA CANCER FOUNDATION (Pigeon Lake Pedal)

        b) CREDIT CARD Pay for your registration or make a donation on line by going to https://secure.csfm.com/acf/**Please enter Pigeon Lake Pedal in the Event Name box.

            Credit card payment by phone (780) 643-4418  Toll free 1 866 412-4222 or  fax (780) 643-4398.

    3. Mail, fax or deliver the Registration form (after ensuring payment by one of above methods) to:

            Pigeon Lake Pedal c/o Charissa Spencer,  Alberta Cancer Foundation,

             #710, 10123-99 St, Edmonton, Alberta T5J3H1

    4. Collect pledges - complete pledge forms make sure all information is collected for tax receipts.

                                        100% of proceeds benefit patients and cancer research.

1 entry for prize draw for every $100 collected by July 5, 2008

Questions?  Contact Charissa (780) 643-4418 e-mail charspen@cancerboard.ab.ca