2022 Ride for Dragonfly presented by The Basement Doctor REGISTRATION & SPONSORSHIP FORM

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2022 Ride for Dragonfly presented by The Basement Doctor REGISTRATION & SPONSORSHIP FORM

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JOIN US ON AUGUST 27th FOR THE 5th ANNUAL RIDE FOR DRAGONFLY

presented by The Basement Doctor

If you prefer to pay by check, please email a.brokaw@dragonfly.org. Payment can be mailed to The Dragonfly Foundation at 506 Oak Street, Cincinnati, OH 45219.

All makes and models are welcome!
REGISTER before August 8th and receive a free t-shirt
This is a DRY RIDE until kickstands are down at Queen City Harley-Davidson in West Chester, OH.
No colors, please.
WAIVERS & MINORS
If you would like to purchase a t-shirt, please email Ally Brokaw at a.brokaw@dragonfly.org. Short sleeve shirts are $15. Long sleeve shirts are $20.

EVERY adult must sign the Adult Waiver Form ON THE DAY OF THE RIDE.
CHILDREN MUST BE 16 YEARS OR OLDER TO RIDE AS A PASSENGER
OPERATORS MUST BE 18 YEARS OLD TO PARTICIPATE

Registrant/Sponsor Information

First Name

Last Name

Company Name

Street Address

City

State

Zip Code

Work Phone

Mobile Phone

Please use hyphens, not periods or slash marks

REQUIRED: Are you a RIDER or a BLOCKER?

RIDER REGISTRATION (ALL MAKES WELCOME!)

Number of Bikes with One Rider ($20)

Number of Bikes with 2 Riders ($25)

SUBTOTAL: RIDER REGISTRATION

****SPONSORSHIP OPPORTUNITIES ARE NOW CLOSED***

CLICK HERE IF YOU ARE INTERESTED IN A PAYING FOR A CONFIRMED SPONSORSHIP

If you are paying for a previously confirmed sponsorship please check the box above.

Sponsorship Opportunities are now CLOSED, thank you for your support. Please use this form to pay for a confirmed Sponsorship

SPONSORSHIP

SUBTOTAL SPONSORSHIP

NEXT: Payment Information

Page 2 of 3: REGISTRANT/SPONSOR INFORMATION

One t-shirt with single registration and two with a double rider registration.

Sponsors will receive a free shirt/rider included in their sponsorship level.

P lease email your shirt size to a.brokaw@dragonfly.org

Additional shirts may be purchased for $15/each.

TOTAL: REGISTRATION & SPONSORSHIP

REGISTRATION SUMMARY

Sponsorship Cost

Single Rider Registration ($20/each)

Double Rider Registration ($25/each)

TOTAL

Payment Information

Name As It Appears On Card

Card Number

Code

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