1. Come join the fun and support GDA!
Raffle prizes!
Poker Run
$ purse
High Hand $200 2nd Place $100 Low Hand $200
Free food at the end of the run!
Saturday, August 26, 2017, 7:30 a.m First ride out 8:00 a.m. - Last ride out 9:00 a.m.
Starts at District W24 Hall
25 Cornell Ave., Gladstone, OR
Each rider and passenger will receive an event t-shirt
Pre-registration must be received by August 20, 2012 at:
IAM&AW Local 63
25 Cornell Ave
Gladstone, OR 97027
Registration: $35.00 Donation per rider, $10.00 per passenger
Please make checks payable to Local 63 Guide Dog Dash
Pre-registration is appreciated
ALL PROCEEDS BENEFIT GUIDE DOGS OF AMERICA
Registration (Please Print)
Name (Rider):____________________________________________ Age_______
Address ________________________________ Telephone (____) __________
City, State/Province, Zip Code ________________________________________
Motorcycle: Make ____________________ Model __________ Year ______ LIC#________
Name (Passenger):_______________________________________ Age _______
Address _________________________________Telephone (____) __________
I understand that state law requires vehicles and drivers/riders to be appropriately licensed and endorsed and to have their own liability insurance to operate on state roads and highways and that it is my responsibility to provide that insurance. I, therefore, release and hold harmless IAM&AW District W24, Local 63 Guide Dogs of America event volunteers, sponsors/supporters, participating merchants and event site owners and personnel from any responsibility for any damage or injury I may incur or cause while participating in this event.
I have read this form and agree to the above statement (Signature required).
__________________________________________ ______________________________________
Rider Signature Date Co-Rider/Passenger Signature Date
Shirt
Size_______
Shirt
Size_______