A Little Wiggle Room

Charity Ride On-Line Entry Form

SEPTEMBER 20, 2008

Check-in and registration will be from 8:00am to 10:30am the day of the ride. All riders and passengers will be required to sign a waiver at that time in order to ride. Registration fee includes Charity T-shirt and lunch from Chick-Fil-A

Riders Name:
Address:
City:
State:
Zip:		Rider Fee	$30.00
Phone:
Cell:
** E-mail:
	If no passenger leave blank
Passenger's Name:
Address:
City:
State:
Zip:		Passenger Fee	$15.00
Phone:
Cell:
**E-mail:

** We value your privacy. Your E-mail address will only be used to notify you of any changes to this event and or to notify you of future events and will not be sold or given to anyone for any other purpose without your permission.

After completion of form, click the Submit button below to send information. Do not hit Submit or Enter until you are ready to send your information.

Thanks you for your support

Rider Fee	$30.00	Checks should be made payable to :
Passenger Fee	$15.00	Center Grove Education Foundation

		Mail to:	A Little Wiggle Room c/o Cindy Price 501 San Marcos Drive Greenwood, IN 46142

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