Biker Ralley Application Form


Abundant Life United Pentecostal Church 

Sussex, New Brunswick, Canada

OFFICIAL APPLICATION & PLEDGE FORM

“Cruzin’ For Christ” 2011 Biker Rally 

NAME: __________________________________________              

  ADDRESS: ________________________________________

CITY: __________________________________________    PROV/STATE: ___________       POSTALCODE: _________________

YOUR E-MAIL: __________________________________         Will You Need Accommodations?   Y ___           # 0f People? ____

Have you previously participated in any motorcycle group ride? Yes___   No ___;   In our previous ride(s)? Yes: ___  No: ____

Are you a: Biker? ___       Passenger? ___                 (Would you be willing to ride with a passenger?)            Yes ___   No: ____

ˆ         YES I have a valid motorcycle driver’s license, an approved helmet and my motorcycle is insured. 

WAIVER:I understand and am aware that there are dangers and risks involved in riding a motorcycle and in riding a motorcycle in a group such as “Cruzin’ for Christ”. These dangers and risks include damage, injury, serious injury and/or death. Knowing and appreciating fully these dangers and risks, I, the undersigned, hereby waive, release and forever discharge “Cruzin’ for Christ”, the proceed recipient, the Atlantic District of the United Pentecostal Church International, Abundant Life United Pentecostal Church and their Men’s Fellowship members &/or guests, members of the organizing committee, sponsors, supporters, volunteers, and all other associates with the event of and from all manner of actions, causes of actions, suits, debts, claims and demands whatsoever arising from or in connection with the “Cruzin for Christ” ride and any associated events. I assume full responsibility for injury or damage arising as a result of the participation association with “Cruzin’ for Christ” and for my passenger(s). This waiver also includes a ‘model release’ for photographs taken and audio/visual recordings made while participating in the above activities.

                Signature: _____________________________________________________   Date: ____________________

All pledges must be collected and submitted before the ride begins. Receipts will be issued for donations of $10.00 or more, provided the name and address are complete and legible. Make all cheques payable to “Abundant Life United Pentecostal Church”.                                                                                                                        DISTRICT CONFERENCE     

SPONSOR NAME

ADDRESS

POSTAL CODE

 AMOUNT CashOr

Cheque

Your name is 1st then list your sponsors

Minimum biker registration (fee plus pledges) is $99.00

Fees cover costs of 4 meals & bottled water

 

 

  
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Please e-mail us if you will be attending this year’s ride.

Back Seat Riders – please submit a

Separate entry form. Rider Fee is $50.00

       
  Minimum Biker Registration (fee plus pledges) is $99. 00 TOTAL    

Please make photocopies of this sheet for additional pledges.  This sheet is PAGE # ____ of ______ for your total pages.

Our e-mail is holyroller@bellaliant.net            Our fax # is: (506) 433-8147            Our ‘Phone # is: (506) 434-5800

For additional information on our entire week-end’s “Cruzin’ for Christ” Biker Rally and activities go to: www.alsussex.com

Join our Facebook group…… “Cruzin for Christ” ….   It gives you photos from 2010 and details for 2011