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bikes@slvhabitat.org
(719) 589-8678
$ODPRVD&2
32%R[
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Ride capped at 300 riders.
Fill out this form and sign the Release below. Send registration with donations
postmarked by July 15. Confirmation, Map & Directions will be sent by email. Entry: Donations
$100 per rider
______________________________________________________________
First Name Last Name
Mail This Completed
_____________________________________________________________________________________ Form & Donations :
Address City, State Zip SLV Habitat for Humanity
_____________________________________________________________________________________ P.O. Box 1197
Phone Email ( * for Confirmation info) Alamosa, CO 81101
_____________________________________________________________________________________ Lunch Organized for
Date of Birth Age Gender
Riders in La Veta
_____________________________________________________________________________________
Emergency Contact Relation Phone T-Shirt Size
S M L XL XX
_____________________________________________________________________________________
Address City, State Zip