Cruisin' with St. Jude
Registration Form
Name: ____________________________________________
Address: _______________________________________________________________________________
City/State/Zip: __________________________________________
Telephone: ____________________________
Email Address: _______________________________________
Bike: ____________________________________ (List year/make/model)
Drivers License #: _________________________ State: ___________________
Insurance Co.: ___________________________ Policy No.: _________________________
T-shirt size: _____ SM ______ M _____ L _____ XL _____ XXL (Adult sizes only)
Total donation enclosed with reg. form: _________________ ($35.00 per bike) *inc. 1 hand and (St. Jude t-shirt and pin if registered by May 1)
Please mail this form and check/money order to:
To Serve Him.com, LLC
Pamela Manley
120 Brookfield Drive
Stockbridge, GA 30281
Disclaimer:
St. Jude Children Hospital and To Serve Him.com will not be held liable for any
damages, theft, or injuries that might occur on the day of the ride. All
riders are responsible for their bike(s) during the entire ride. Thank you in advance for your participation and help in benefiting St.
Jude Children's Research Hospital!!