Registration Form  Pigeon Lake Pedal Saturday, July 4, 2009

NEW!! *FREE REGISTRATION if $500 in pledges collected&submitted to Alberta Cancer Foundation by July 2, 2009!

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 $35 per person (free with $500 collected, submitted pledges by July2)
$_______________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. NEW Register online or Complete and sign this Registration form.

    2. Pay Registration fee (*or submit $500 in donations by July 2, 2009 for FREE registration):

        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 http://donate.albertacancer.ca/netcommunity/pigeonlakepedal

            Credit card payment by phone (780) 432-8365 Toll free 1 866 412-4222 or  fax (780) 432-8357.

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

            Pigeon Lake Pedal c/o Michelle Ponich,  Alberta Cancer Foundation,

             11560 University Ave, Edmonton, AB, T6G 1Z2

    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 4, 2009

Questions?  Contact Michelle (780) 432-8365 e-mail michelle.ponich@cancerboard.ab.ca

 www.pigeonlakepedal.com