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Entry Fee per motercycle or vehicle is $10.00
Passengers are free.
Do you wish to pay for an entire group or organization with one payment?
YES
NO
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Choose your state and state code
125 Alabama
148 Alaska
130 Arkansas
142 Arizona
147 California
140 Colorado
115 Connecticut
117 Dele ware
105 Florida
126 Georgia
149 Hawai
144 Idaho
106 Illinois
107 Indiana
129 Iowa
134 Kansas
122 Kentucky
131 Louisiana
113 Maine
114 Massachusetts
103 Michigan
128 Minnesota
124 Mississippi
101 Missouri
138 Montana
135 Nebraska
150 Nevada
112 New Hampshire
116 New Jersey
141 New Mexico
109 New York
100 North Carolina
137 North Dakota
102 Ohio
146 Oregon
133 Oklahoma
108 Pennsylvania
110 Rhode Island
127 South Carolina
136 South Dakota
123 Tennessee
132 Texas
143 Utah
111 Vermont
120 Virginia
119 Washington DC
145 Washington
121 West Virginia
104 Wisconsin
139 Wyoming
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What County do you live in?
PROJECT PREVENT NATIONAL EVENT REGISTRATION APRIL 20, 2008 THE LARGEST ORGANIZED RIDE IN UNITED STATES HISTORY JOIN US AND UNIFY BRINGING ALL AWARENESS GROUPS TOGETHER AS ONE VOICE
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First Name
*
Last Name
*
Street Address
Address Line 2
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City
*
State/Province/Region
*
Zip/Postal Code
*
Would you like to organize a ride in your local area and state?
Yes
No
Maybe
*
Country
*
Phone Number
*
How many passengers will you have?
ONE
TWO
THREE
FOUR
FIVE OR MORE
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Email Address
*
Which prevention awareness group do you want your donation to help out with?
HUNGER
PARENTAL ALIENATION
CHILD ABUSE
SUICIDE
TEEN PREGNANCY
DRUG ADDICTION
ALCHOHOL ABUSE
DOMESTIC ABUSE
SEXUAL CRIMES
VIOLENT CRIMES
GANGS AND VIOLENCE
SHAKEN BABY SYNDROME
SIDS
BIRTH DEFECTS
CANCER
DRUG USE DURING PREGNANCY
EMOTIONAL ABUSE
CORRUPTION GOVERMENT AND OR COURTS
SEXUAL TRANSMITTED DISEASES
ABUSE AND OR SUICIDE OF SOLDIERS
STATE INCENTIVE FUNDS THAT DESTROY FAMILY
ONLINE SEXUAL PREDITORS
CORRUPTION IN PRISONS AND JAILS
PHYSICAL ABUSE
ADOPTION SCAMS CLOSED AND OPEN
MISUSE OF GOVERMENT FUNDS
BIRTH DEFECTS
PARENTAL KIDNAPPING
MISSING CHILDREN
OTHER
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Will you be in a ride that is outside the state or county which you live in?
Yes
No
I don't know
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Would you like to be added to our monthly email letters to show you the results from this ride and current news?
YES, I want to know
No, I am here just for the ride!
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What state and county will you be riding in?
*
Which Category do you fall under for this ride?
Motercycle rider no passenger
Motercycle rider with passenger
Motercycle rider/side car with passengers
Auto Driver no passengers
Auto Driver with passengers
Driver with media equiptment
Driver with PA system
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What year make and model of motercycle or vehicle will you be riding or driving?
*
Are you riding with an organization, group, or club?
YES
NO
*
What is the name of the organization, group or club your riding with?
If None just type N/A
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Would you or your organization like to sponcer this ride?
YES
NO
MAYBE
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What is your occupation?
*
Your ride position depends on when your entry form and fee is recieved.
The county and state you live in determines the codes that will be on your ride entry bracelet this ensures an accurate count to show this to be the largest ride in U.S. history.
How Important is it that you ride with a certain group, organization, motercycle, auto club, or friends you know?
Very Important
Not Important
Somewhat Important
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How do you want to get your ride entry bracelet or bracelets?
Your entry bracelet options are below but make sure you provide us with mailing information where you want them sent to if your in a club or organization by emailing
cedartree79@aol.com
or call 336-643-9872 for large organizers and clubs, so we know who and where to send them to.
Please mail it to me
I will pick it up at the check in point
Send it to the leader of our group
Send it to our organization
Send it to our motercycle club president
Send it to our auto club president
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Please contact us at 336-643-9872 with any special questions or if you have any special needs.
Do you have any ideas or suggestions that will help make this ride a success!
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If you are paying for a group or organization in one payment. You will need to get entry forms for each rider or driver filled out.
How would you like to recieve the forms for organizations or groups?
Online forms that do not require payment
Mail the forms after you recieve payment
Im Using the easy print forms to send you
I want another option
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Amount I want charged on my credit card.
*
Number of riders or drivers your paying entry fees for?
*
Name on Card
*
Credit Card Type
Visa
MasterCard
American Express
Discover
*
Credit Card Number
*
CSC Code
*
Expiration Date (mm/yy)
*
If you need a hard copy of this form or want to pay with pay pal or by check in the mail please contact 336-643-9872
Do you need additional copys and an adress to send your payment in?
YES
NO
*
Lets Ride On April 20th, 2008
Do you have any comments or questions?
Please answer below then click submit and get ready to RIDE AND MAKE HISTORY!
LETS FIX THE BROKEN SYSTEM AND PROTECT OUR CHILDREN AND FAMILIES IN OUR AMERICA. TAKE PRIDE IN THE RIDE!
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How would you like to recieve your route and ride updates?
Email me at the email I provided you
Mail the information to my home
Email my group or organization leader
Mail the information to our group
Mail the infomation to the organization
Mail the information to our club president
I prefer a phone call at the number I gave
Bullentins on myspace
Message me on myspace I will send the URL
Info on the ride updates on Bikerornot.com
*
Indicates Response Required
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