Rider Application 2012

Please complete the form below to apply for the ninth annual charity ride from August 3rd to 11th, 2012.

To complete the application by submitting your $150.00 deposit, you should click on one of the charity links, choose your own name and make the donation after you upload the web form.

THEN SEND ME AN E-MAIL AT GREG (at) POSITIVECONTRAST.COM to let me know that you've done that.

Contact Information

Name: *

Nickname:

Street: *

City: *

State: *

Zip Code: *

Home Phone: *

Work Phone:

Cell Phone:

Email Address: *

Birthdate:

Gender:

Male

Female

Rider or Passenger: *

Rider

Passenger

Emergency Contact

Name: *

Phone: *

More About You

Bio For Website:

We will provide one webpage per bike to feature riders and passengers. Please see the current LRLR.org website for examples.

URL of Your Website:

if you would like us to link to you

Email Address:

for publication on website

Bike Information

Make:

Model:

Year:

Owner:

License Plate Number and State: *

Driver's License Number and State: *

Insurance Company Name: *

Policy Number: *

Ride Dates

Dates You Plan on Riding: *

Fees are $1000 for the full ride or $111.11 per day for each bike

File Uploads

Copy of Current Driver's License: *

front and back showing motorcycle endorsement

Copy of Bike Registration: *

Copy of Proof of Insurance: *

Thank you for considering riding with us on this, our ninth annual charity run "Out of the Wings and Into the Wind." We had a great time on the first eight rides and are looking forward to an even better run this trip, the "9th by Northwest"!

To help insure the success of this ride, all riders are required to have the following:

A motorcycle with a range of at least 150 miles between gas stops.
A valid drivers license with the appropriate motorcycle endorsement, where applicable.
Proof of insurance for yourself and the bike that you are riding. For example, if it's your brothers' sisters' uncles' bike that you will be riding, then the insurance must cover your driving it.

Here's what it costs to ride:

The per-bike (or chase vehicle) fee for the full ride is a minimum of $1,000.00 in donations due by July 16th 2012. This includes a $150.00 deposit that should be sent in with your Ride Registration Form.
The day-tripper fee is $111.11 per day, per vehicle. This includes a $111.11 deposit that should be sent in with your Ride Registration Form
Your ride fee goes directly to one of the charities we've identified as a recipient for this years' ride. Also, when you are collecting from friends, family and co-workers, please make sure their checks are payable to the appropriate organization.

Application Checklist:

Please submit the following to:

Long Reach Long Riders, c/o Sapsis Rigging Inc 3883 Ridge Ave, Philadelphia, PA 19132

Your completed application
Copy of Current driver's License (front and back) showing motorcycle endorsement
Copy of bike registration
Copy of Proof of Insurance
Deposit of $150 per bike for the full ride or $111.11 per bike if you are a day-tripper .

IMPORTANT! Checks should NOT be made payable to the Long Reach Long Riders.

Please make checks payable to either BC/EFA (Broadway Cares/Equity Fights AIDS) or Behind the Scenes

Rider Application 2012

To help insure the success of this ride, all riders are required to have the following:

Here's what it costs to ride:

Application Checklist:

IMPORTANT! Checks should NOT be made payable to the Long Reach Long Riders.

Join

Charities

Address

Contact

Copyright

Networking

Broadway Cares/ Equity Fights AIDS The nation's leading industry-based HIV/AIDS fundraising and grant-making organization.
Behind The Scenes Providing support for entertainment industry professionals in crisis.