14th Annual Southern Cruisers , Cruisin for a Cure National Convention
 August 30th thru September 2nd, 2012

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PRE-REGISTRATION FEE: Rider/Single $30.00
INCLUDES:
Special Event Patch show above ( PRE-REGISTRATION ONLY )
 
Dice Run, St. Jude Patch/Pin (first time), 2012 St. Jude Pin Rocker, 2012 St. Jude Patch Rocker, Saturday Night Awards & Auction, Saturday Dinner/Comedy Show
Passenger/Spouse (with or without bike) -$25.00 Includes: Same as above

Comedian John Morgan
http://www.johnmorgancomedy.com/

c
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REGISTRATION FEE at the Table: Rider/Single $35.00
INCLUDES:

 
Dice Run, St. Jude Patch/Pin (first time), 2012 St. Jude Pin Rocker, 2012 St. Jude Patch Rocker, Saturday Night Awards & Auction, Saturday Dinner/Comedy Show
Passenger/Spouse - $30.00 Includes: Same as above

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Main St. Jude Patch will be sold at the Event: Extra Main Patch or Pin $6.00 ea, Extra Patch or Pin 2012 Rocker $3.00 ea
Dice Run Sheet $10.00 ea; Saturday Night Dinner/ Comedy Show $17.00 ea.
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Pre-Order for T- Shirts
CLICK LINK ABOVE


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

Personal Registration

Please fill out this form and print
Mail To: 

  James Prescott
  13128 Hwy 5 South
  Norfork, Arkansas 72658

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 - $30
.00     With  Passenger  $55.00
                                                                                                      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 Event
re

Please send Check or Money Order to

James Prescott
13128 Hwy 5 South
Norfork, Arkansas 72658

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.

 




 
 
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