2016 Pledge Sheet - Prostate Cancer Fight Foundation

telus motorcycle ride for dad
ride information
Register online today!
Pre-registration
You can now add cash pledge amounts
to your online total! Register online and
use this form to collect cash pledges.
Friday June 10
5–8 p.m.
Scugog Community Recreation Centre
Pad 1 West Side
1655 Reach Street, Port Perry
r id e day
We give where we ride!
Opening ceremony 9:30 a.m.
Kickstands up 10 a.m. SHARP
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PROUDLY
SUPPORTED BY
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participants will receive a chance to
win this custom motorcycle, valued
at $124,000, for every $200 in
donations raised.
Casa Berardi Unit 1st CAV, Country
Style Donuts, Dunbury Developments,
Eagle Eye Custom Cycles, Hellbound Customs, Horizon
Custom Cycle Whitby, K awartha Lakes Fire Department,
Menzies Chrysler, Milestone Motorsports, Port Perry
Overhead Doors, Roughley Insurance Brokers Ltd.,Scugog
Fire Department Port Perry, Selwyn Fire Department
durham & gte
10th anniversary ride!
Raise to ride! Registered
RideForDad.ca
saturday june 11
See RideForDad.ca for
details and contest rules.
BRONZE SPONSORS
AEROGRAPHICS CREATIVE SERVICES
Download our
free mobile app!
SILVER SPONSORS
Register online today at
Become a volunteer, sponsor,
pledge a rider, make a donation,
or register as a non-riding Champion!
RideForDad.ca
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You don’t need to be a rider
to get involved!
Register or donate online at
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To date, the Ride For Dad has donated
more than $18 million towards prostate
cancer research and awareness!
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a
Gift for first 250 riders.
Live entertainment.
Free breakfast and lunch.
Lots of prizes to be won!
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Get serious. Talk to your doctor about
getting your prostate checked!
Registration 7:30–9:30 a.m.
a
90% of prostate cancer cases can be
successfully treated if detected early!
Scugog Community Recreation Centre
Pad 1 West Side
1655 Reach Street, Port Perry
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Prostate cancer is the most commonly
diagnosed men’s cancer in Canada.
the telus 2016
Saturday June 11
o
What’s raised in your community stays in
your community to help fight prostate cancer
through research and public awareness.
GOLD SPONSORS
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Registering online helps save administrative
costs and helps us plan a better event.
PLATINUM SPONSORS
TITLE SPONSOR
NATIONAL SPONSOR
Special thanks to all prize contributors and all volunteers.
@TELUSRideForDad
fighting prostate cancer RideForDad.ca
TE LU S Motorcycle Rid e Fo r Dad REG IST RAT IO N FO R M
 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)
T ELU S M o to rcycl e R i de Fo r Da d PL E DG E FOR M
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
I’m riding with team/club/legion branch (if applicable)
Address
Floor/apt. #
City
Vehicle manufacturer  Harley-Davidson®  Honda  Kawasaki  Suzuki  Yamaha  BMW  Other
Donor name
Tel
Email
Address
Floor/apt. #
City
Email
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
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
Address
Floor/apt. #
City
Gender  Male  Female
Captain’s Club # (if applicable)
Address
City Prov
Phone (home) Postal code
Postal code
(work)
Birth year
Is this city your preferred Ride location?
 Yes  No, I usually ride in this location
Postal code
Postal code
Postal code
Postal code
Postal code
Postal code
 Please add my name to the MRFD E-news distribution list.
 YES, I have a valid motorcycle license, approved helmet and insurance required to participate.
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 the TELUS Motorcycle 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 Motorcycle 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 Motorcycle 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 Motorcycle 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
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.
Date
For administrative use only:  Rider  Participating Passenger  Champion  Volunteer  Waived
Postal code
Postal code
Postal code
Total pledges on this sheet
Personal pledge
Registration fee
Total overall