2016 Pledge Sheet - Prostate Cancer Fight Foundation

telus snowmobile
ride for dad
Important information
Register online today!
Friday, February 12
7–9 p.m.
Timberline Snowmobile Club
2 Henan Road, Pembroke
Pre-registration
Registering online helps save administrative
costs and helps us plan a better event.
R id e day
We give where we ride!
Fifth Anniversary Ride!
Saturday, February 13
What’s raised in your community stays in
your community to help fight prostate cancer
through research and public awareness.
Timberline Snowmobile Club
2 Henan Road, Pembroke
Prostate cancer is the most commonly
diagnosed men’s cancer in Canada.
Ride departs Trail 139 at 10 a.m. SHARP
SILVER SPONSORS
Ken BERTRAND
Register online today at
RideForDad.ca
r
a
d
2 016
y
r
a
i v
courtesy of
e
BRONZE SPONSORS
A $3,000 SHOPPING SPREE
courtesy of
e
a r
v
a n n i
e
r
Raise to ride! Registered
Tony Donnelly
Ken BERTRAND
Register or donate online at
ile ride f
o
PemBroKe
y
Become a volunteer, sponsor,
pledge a rider, make a donation,
or register as a non-riding Champion!
ob
2 0 11
A $5,000 SHOPPING SPREE
You don’t need to be a rider
to get involved!
m
d
EVERY $100 RAISED GIVES
YOU A CHANCE TO WIN
w
f
To date, the Ride For Dad has donated
more than $18 million towards prostate
cancer research and awareness!
Registration 8–10 a.m.
s
Get serious. Talk to your doctor about
getting your prostate checked!
the telus 2016
o
90% of prostate cancer cases can be
successfully treated if detected early!
ARNPRIOR–PEMBROKE–RENFREW
sn
You can now add cash pledge amounts
to your online total! Register online and
use this form to collect cash pledges.
GOLD SPONSORS
participants will receive a chance to
win this custom motorcycle, valued
at $124,000, for every $200 in
donations raised.
pembroke
fifth anniversary ride!
saturday february 13
See RideForDad.ca for
details and contest rules.
ARNPRIOR–PEMBROKE–RENFREW
RideForDad.ca
MEDIA SPONSORS
@TELUSRideForDad
TITLE SPONSOR
NATIONALLY
SUPPORTED BY
LOCAL
PRESENTING
SPONSOR
PROUDLY SUPPORTED BY
AEROGRAPHICS CREATIVE SERVICES
SRFD 2016 Pledge_Pembroke.indd 1
fighting prostate cancer RideForDad.ca
2016-01-05 8:36 AM
TELUS Snowmobile Ride For Dad REGISTRATION FORM
 I HAVE REGISTERED ONLINE (if you have cash/cheque pledges, please complete this form and
bring it, along with your additional pledges, to the Express Registration line on Ride Day)
TELUS Snowmobile Ride For Dad PLEDGE FORM
All pledges must be collected and submitted before the Ride begins. Receipts will be issued for donations of $20 or more, provided name and address are
complete and legible. Make all cheques payable to “Ride For Dad.” Working in partnership with the Prostate Cancer Fight Foundation, charitable registration
#851333179RR0001. Donors, thank you for providing your email address! This will help reduce our costs by allowing us to provide you with an e-receipt.
Name Amount
Donor name
Tel
Email
Address
Floor/apt. #
City
Donor name
Tel
Email
Address
Floor/apt. #
City
Donor name
Tel
Email
Address
Floor/apt. #
City
Donor name
Tel
Email
Address
Floor/apt. #
City
Donor name
Tel
Email
 I’d like to make a personal pledge towards my fundraising goal $
Address
Floor/apt. #
City
How did you hear about the Ride?
 Television  Radio  Print  Friend  Dealership  Social media
Donor name
Tel
Email
Gender  Male  Female
Captain’s Club # (if applicable)
Address
City Prov
Phone (home) Postal code
(work)
I’m riding with team/club/legion branch (if applicable)
Vehicle manufacturer  Arctic Cat  BRP (Ski-Doo)  Polaris  Yamaha  Other
Email
Birth year
Address
Floor/apt. #
City
Is this city your preferred Ride location?
 Yes  No, I usually ride in this location
Donor name
Tel
Email
 Please add my name to the SRFD E-news distribution list.
Address
Floor/apt. #
City
 YES, I have a valid license to operate a snowmobile, approved helmet, valid insurance and trail pass.
All are required to participate.
Donor name
Tel
Email
Address
Floor/apt. #
City
Donor name
Tel
Email
Address
Floor/apt. #
City
Donor name
Tel
Email
Address
Floor/apt. #
City
WAIVER
I understand and am aware that there are dangers and risks involved in riding a snowmobile, and in riding a
snowmobile in a group such as the TELUS Snowmobile Ride For Dad. 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 the TELUS Snowmobile Ride For Dad, the proceed recipient, the police,
members of the organizing committee, sponsors, supporters, volunteers and all other associates with the event
of and from all manner of actions, causes of action, suits, debts, claims and demands whatsoever arising from
or in connection with the TELUS Snowmobile Ride For Dad and associated events. I assume full responsibility for
injury or damage arising as a result of the participation association with the TELUS Snowmobile Ride For Dad
event and for my passengers. This waiver also includes a “model release” for photographs taken and audio/
video recordings made while participating in the above activities.
Signed
Date
SRFD 2016 Pledge_Pembroke.indd 2
Registration is $30 and can be converted to a donation or refund if you raise a minimum of $100 in pledges.
For registration dates, times and locations, go to RideForDad.ca.
Passengers must register to participate in ride activities, prize draws and meals. There is no charge for passengers who do not.
PLEASE PHOTOCOPY THIS PAGE FOR ADDITIONAL PLEDGES.
For administrative use only:  Rider  Participating Passenger  Champion  Volunteer  Waived
Postal code
Postal code
Postal code
Postal code
Postal code
Postal code
Postal code
Postal code
Postal code
Postal code
Total pledges on this sheet
Personal pledge
Registration fee
Total overall
2016-01-05 8:36 AM