Washington Lodge and PA Chapter XVI
#164 F & AM Blue
Knights
Are co-sponsoring their Sixth Annual
Charity Motorcycle Run; Proceeds from the run
will be divided between the two organizations, and used to support area
charities.
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The ride will be
held on Sunday July 26, 2009, Rain or Shine.
Registration will be at North Strabane Twp.
Volunteer Fire Department on Rt19
Canonsburg PA from
9am to 11 am, and we will depart promptly at 11:30.
The cost for the
ride is $20.00 single, and $30.00 double.
Pre-Registration
preferred by July 20, 2009. Pre-Registered riders will receive a free
year bar, otherwise
they will be $5.00 on the day of the ride.
Make Checks Payable
to: “Blue
Ride Fund”
Send to: PO Box
422, Eighty Four, PA 15330
Pre-Registrations are NON REFUNDABLE
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REGISTRATION FORM
I the undersigned do hereby acknowledge that my
participation in this event is voluntary.
I do hereby
release the following entities from any and all claims of
liability, for any injuries sustained to my person,
OR my
motorcycle OR vehicle, by my participation in this event: Blue Knights PA Chapter XVI; and
Washington Lodge No. 164 F&AM; and all employees,
sponsors, and or members thereof, or assistants and
or affiliates thereto, including their professional,
personal, and or corporate holdings.
DRIVER
Name: _________________________________________ Phone:
_______________________ Age: _____
Add:ress_______________________________________________________________________________
Signature:
_____________________________________________________ Date: ___________________
Please provide an Email Address if you have
one______________________________________________
RIDER
Name: ___________________________________________
Phone: _____________________ Age: _____
Address__________________________________________________________________________________
Signature:
______________________________________________________ Date: __________________
***** ***** ***** *****
For More
Information:
Dave Richards - drichards@northstrabanepolice.com
– 724-746-8474