NAME:
STREET ADDRESS:
CITY:                                    STATE:      ZIPCODE:                                       
DAY TIME PHONE NO.:
EMAIL ADDRESS:
T-Shirts Sizes
Adult:
S, M, L, XL, XXL, XXXL
Child:
S, M, L, XL

Please indicate your participant category
If more than one registrant, please fill out
separate registration form for each participant
Adult:
Child: 12 and Up
Click thumbnail for larger image
Click "Submit" to Register


Click Reset to Clear Registration Fields




Please make Check or Money Order Payable To:

Edward Van Wagner, indicate Faith Jade Memorial Ride 2010
in the Memo Section and mail to:
Faith Jade Memorial Ride
c/o Edward Van Wagner
3516 New St., Valatie, NY 12184
Those Registering for the BBQ Only may purchase a Shirt for $15 below
DONATION
   ONLY     
required
Toddler and infant t-shirts available by special order only
Onesie - White only $15
PLUS $8 SHIPPING
Infant/Toddler - White only  $15
PLUS $8 SHIPPING
Click thumbnail for larger image
Click thumbnail for larger image
FOR WALKERS ONLY
YOU MAY OPT TO DO A PLEDGE SHEET  IF YOU'D LIKE. PLEASE INDICATE BELOW
and PRINT A PLEDGE SHEET BY CLICKING THE LINK TO THE RIGHT

ATTENTION: MOTORCYCLE RIDERS
PLEASE READ THE RULES AND SUBMIT CONFIRMATION
BEFORE SUBMITTING REGISTRATION
NOTICE:
Shirts are only available for online and mail in
Pre-Registration Only. They will not be for sale the day of the event except by special order only.
Motorcycle Rider
Motorcycle Rider
Motorcycle Passenger
Motorcycle Passenger
Walker
Walker
BBQ Only
BBQ Only
0-6 Months
0-6 Months
For Paying by                         Only!
For Paying by                          Only!
OR
There is a $3.00 Charge added for using PayPal Included at Checkout
There is a $3.00 Charge added for using PayPal
                      Included at Checkout
There is a $3.00 Charge added for using PayPal
                      Included at Checkout
                  ATTENTION:
Paid  Motorcycle Rider/Passenger, Bicycle and Walker Participants- Please indicate Shirt Size. Choose Only One.
2T
2T
3T
3T
4T
4T
6-12 Months
6-12 Months
12-18 Months
12-18 Months
18-24 Months
18-24 Months
ADULT and CHILD T-SHIRTS
View shopping cart
View shopping cart
Small
Small
Medium
Medium
Large
Large
XL
XL
XXL
XXL
XXXL
XXXL
ADULT T-SHIRTS
CHILD T-SHIRTS
Small
Small
Medium
Medium
Large
Large
XL
XL
ONESIE
INFANT
AREA BELOW IS FOR  "PURCHASING" SHIRTS ONLY
Use PayPal Buttons below for Registration Payment and T-Shirt Purchasing only.
Printable_Registration_Form.pdf
Printable_Registration_Form.pdf
For faster service use PayPal to make an online
donation or you may mail it in by following the directions below
$5
$5
$10
$10
$20
$20
$25
$25
$50
$50
$100
$100
Faith_Jade_Memorial_Ride_Walk_Pledge_Sheet.pdf
Faith_Jade_Memorial_Ride_Walk_Pledge_Sheet.pdf
PRINTABLE PLEDGE SHEET
PRINTABLE REGISTRATION FORM
0-6 Months
6-12 Months
12-18 Months
18-24 Months
2T
3T
4T
PLEDGENON PLEDGE