Registration Form

Please Copy & Print this Page
June 17th, 2012
Tour de Unity Bike Ride
Registration Form


Registration Fee: $25 thru 6/6
$35 Day of Ride . Cannot Guarantee Shirt day of Ride
Complete this form and send it with your non-refundable, non-transferable registration fee to:
Must Also Include Wavier
Unity Gardens
PO Box 10022
South Bend IN 46680

Name:____________________________________
Address:__________________________________
 City State Zip______________________________
Email Address______________________________
Date of Birth (must include year)___________________
 Sex: Circle One    Male   Female
Home Phone: ______________________
Cell Phone:    ______________________
Shirt size:  circle one  S   M L XL XXL
�� Enclosed is my check payable to Unity Gardens Inc.

Sign: _________________________________________