Register online at www.spondoro.com
or print and mail the form below.
Mail form to:
Pedal For Patients
530 E Main St
Weiser Idaho 83672
www.Pedalforpatients.com
______________________
Name
______________________
Address
_______________________
City / State / Zip
_______________________
Phone
_______________________
E-mail
Age___________
$10 Late fee after Aug 15
o 20 miles $25 ($35)
o 40 miles $35 ($45)
o 68.7 miles $45 ($55)
o 100 miles $45 ($55)
o Under 13 years $15 ($25)
*Make Checks payable to Saint Alphonsus-Ontario Foundation