Dairy Products Inc.

Ride for WishesTM
In me
mory of Chuck Worden
to benefit
Make-A-Wish Minnesota

Brought to you by:


92 KQRS


Fury Motorcycles


Streamline Design

Registration Form

This online registration accepts payment via
Solution Graphics


Driver: Cost = $25.00    (The first 50 to pre-register by 5/28/2018 will receive one free t-shirt)
First Name:       Last Name: 
By checking this box, I certify that I will be 18 years old or older
on the date of the bike run, Saturday, June 02, 2018.
Note: Proof of age will be required on the day of the event.
Address:     Apt: 
City:     State:     Zip: 
Phone: ( ) -  Ext:
E-mail:

Passenger: (Cost = $15.00)
First Name:       Last Name:  

I would like to help the kids with an additional cash donation of: $

You are one of the first 50 to pre-register by 5/28/2018, please select your free t-shirt.
T-Shirt
Medium
T-Shirt
Large
T-Shirt
XL
T-Shirt
XXL
T-Shirt
XXXL
Ladies Tank Top Medium
Ladies Tank Top Large
Ladies Tank Top XL

Pre-order additional t-shirts now - Indicate quantity below each size. There is a limit of 2 additional t-shirts per pre-registration.

NOTE: On the day of the event, Saturday, June 02, 2018 , a limited supply of T-shirts will be available. Order now to guarantee that you get yours.

T-Shirt Medium
$12.00/ea
($15.00 day of event)
T-Shirt Large
$12.00/ea
($15.00 day of event)
T-Shirt XL
$12.00/ea
($15.00 day of event)
T-Shirt XXL
$12.00/ea
($15.00 day of event)

T-Shirt XXXL
$12.00/ea
($15.00 day of event)
Ladies Tank Top Medium
$12.00/ea
($15.00 day of event)
Ladies Tank Top Large
$12.00/ea
($15.00 day of event)
Ladies Tank Top XL
$12.00/ea
($15.00 day of event)
Sub-total :