12th Annual Southern Cruisers , Cruisin for a Cure National Convention
 August 19th thru August 22nd, 2010
_____________________________________________________________

PRE-REGISTRATION FEE: Rider/Single $25.00
INCLUDES:
 Dice Run, Pin (first time), 2010 Pin Rocker, 2010 Patch Rocker, 
 Saturday Night Awards & Auction
Passenger/Spouse (with or without bike) -$15.00 Includes: Same as above
___________________________________________________________________

 T-Shirts and Main St. Jude Patch will be sold at the Event: Extra Pin $5.00, Extra Rocker $2.00
___________________________________________________________________


Secure On-Line Registration by Visa or Master Card Only
    Click here...

Personal Registration

Please fill out this form and print
Mail To: 
  WILL NEED TO REGISTER AT RALLY

SCRC Cruisin for a Cure / St. Jude Registration Form
 
          Rider/Single
       First Name                                            Last Name

   


       Passenger/Spouse (with or without bike)
       First Name                                         
                   

 

 Last Name


SCRC Chapter Name

  


Street Address

  

 

City

 State/ Prov            Zip/Postal Code    

            

Home Telephone

 Work or Cell Telephone

   

   
Email Address
 		Other source of contact
  
  SCRC Officer
   Yes   No    
 
 
Please select the options below.
Pre-registration Only
Single  Rider - $25.00     With  Passenger  $40.00
                                                                                                      Total Amount     

                                                                                                                           
 
  Undetermined at this time
 Number Of Donations  "$10.00 each"                     Total Amount     
 
           Total Amount of Check or Money Order  
 
 

  Will you be attending the SCRC Awards & Auction on
Saturday Night, or the SCRC Dice Run on Saturday.

Awards
 
Dice Run
 

Please Make Checks payable to Crusin For A Cure,
 with the Southern Cruisers Name in the
"FOR" section of the check.

ePlease Read
WAIVER OF LIABILITY
Click Here

Waivers are
signed at
the Eventre

Please send Check or Money Order to

James Prescott
WILL NEED TO REGISTER AT RALLY
Name or Email address of person who referred you
(please leave blank if no one referred you)

All Information is kept Private and not giving out to any other parties.

 



 
 WEBMASTER