​Ride for the Relay 2019 

Highlight this form, print it, fill it out and mail it to the address at the bottom.
“Ride for the Relay 2019”

September 7, 2019
Participant Application
Starting Point: _________________________ Ending Point: _________________________


Name: _____________________________________________________________________

Address: ___________________________________________________________________

City/State/Zip: ______________________________________________________________

Telephone: _________________________________ Alt #: ___________________________

eMail: ____________________________________________________________________
Military Veteran:    Y / N       Branch of Service: ___________________What years: ___________

Corporate Sponsor:  (  ) $660
           Pin: Sponsor:  (  ) $330
          Gold Sponsor:  (  ) $132
        Silver Sponsor:  (  )  $66
     Bronze Sponsor:  (  ) $33


Rider/Driver Package:  (  ) $132 --- T-Shirt Size:  S  M  L  XL   XXL   XXXL
Passenger Package:  (  )  $132 --- T-Shirt Size:  S  M  L  XL  XXL  XXXL 

Riders Package Includes:  T-Shirt, Patch, Pin, Windshield Decal, 5 Raffle Tickets,
“All the way Gang” Plaque* and first time “All the way Gang” Patch*.
 

Passenger Package Includes:  T-Shirt, Patch, Pin, 10 Raffle Tickets, “All the way Gang”
Plaque* and first time “All the way Gang” Patch*.
 

*To receive a plaque you must travel the whole “Ride for the Relay” Route.
*To receive the “All the Way Gang” patch it must be your first time to go All the Way. 

Send 2019 Participant Application & check by August 15 to:
Ride for the Relay
C/O Rodger L. Fox
63 East Central Park Plaza
Jacksonville, Illinois 62650
Make all checks payable to Ride for the Relay or American Cancer Society