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