2019 RIDE FOR DRAGONFLY REGISTRATION & SPONSORSHIP FORM

Page 1 of 3

JOIN US 6/15/2019 FOR THE 2nd ANNUAL RIDE FOR DRAGONFLY
SPONSORED BY QUEEN CITY HARLEY-DAVIDSON

This form is for online payment.
If you prefer to pay by check, please email us at Ride@Dragonfly.org. Payment can be mailed to The Dragonfly Foundation at 9275 Governors Way, Cincinnati, OH 45249.

All makes and models are welcome!
This is a DRY RIDE until kickstands are down at Queen City Harley-Davidson in Fairfield, OH.
No colors, please.
WAIVERS & MINORS

EVERY adult that is going to ride must sign the Adult Waiver Form ON THE DAY OF THE RIDE. No signed waiver, no ride!
CHILDREN MUST BE 16 YEARS OR OLDER TO RIDE

Each child must bring this NOTORIZED Parental Consent Form to registration the day of the event: https://dragonfly.org/wp-content/uploads/2018/03/Ride-for-Dragonfly-Waiver-Release-Minor-Parental-Consent-Form.pdf

NEXT: Registrant/Sponsor Information

Page 2 of 3: REGISTRANT/SPONSOR INFORMATION

Registrant Information

First Name

Last Name

Company Name

Street Address

City

State

Zip Code

Email

Work Phone

Mobile Phone

Please use hyphens, not periods or slash marks

REQUIRED: Are you a RIDER or a BLOCKER?

SPONSORSHIP

See Dragonfly.org/Motorcycle for sponsorship benefits

Sponsorship Opportunities

SUBTOTAL SPONSORSHIP

$

RIDER REGISTRATION (ALL MAKES WELCOME!)

Register before 5/9 and each rider will receive a free t-shirt. Once you register, you will receive a link where additional shirts can be ordered.

Number of Bikes with One Rider ($20)

Number of Bikes with 2 Riders ($25)

SUBTOTAL: RIDER REGISTRATION

$

Register or Sponsor Before 5/9 & Receive Free T-shirts (Quantities Limited)

Thanks for sponsoring before 5/9! Your sponsorship entitles you to up to 4 free t-shirts!

Thanks for sponsoring before 5/9! Your sponsorship entitles you to up to 2 free t-shirts!

Thanks for sponsoring before 5/9! Your sponsorship entitles you to 1 free t-shirt!

# OF FREE SHIRTS INCLUDED WITH REGISTRATION

Please Tell Us Your Shirt Size(s)

TOTAL: REGISTRATION & SPONSORSHIP

$

Page 3 of 3: COMPLETE TRANSACTION

REGISTRATION SUMMARY

Sponsorship Cost $

Single Rider Registration $

Double Rider Registration $

TOTAL

$

Payment Information

Name As It Appears On Card

Card Number

MM

YY

Code