PEDAL FOR PATIENTS
Register online at www.spondoro.com or
Print form below and mail to address.

 Registration Form:

Please mail form to:

Pedal For Patients
St. Lukes Msti

1118 NW 16TH ST

Fruitland  ID   83619
www.Pedalforpatients.com

_______________________

Name

_______________________

Address

_______________________

City / State / Zip

_______________________

Phone

_______________________

E-mail

 

 

Ride

Late fee of $10 after Aug 23
 

o 20 miles $20 ($30)
o 20 miles Family with children $15/adult and$10/child early reg. only
o
40 miles $30 ($40)

o 68.7 miles $35 ($45)

o 100 miles $40 ($50)

o Under 13 years $15 ($25)

 

o Additional meal tickets for non riders
 _________x $5 each....................... $________

Chosen ride................................. $________

Additional contribution.............. $________

Grand Total.................................. $________

You can also register online at www.Spondoro.com after June 1, 2009
contact
towner05@gmail.com
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