Pre-Registration Form

Please mail registration fee to:

N.I.V.F.C. Poker Run

78 Lincoln Ave.

North Irwin, PA 15642

ATTN: Denise Harrison

Registration Fees:

Bike: $15.00 Passenger: $5.00

Donations are always welcomed!

Registration fee must be paid on or before July 13, 2008 to be eligible to ride.

Name: DOB: / /

Address:

City: State: Zip Code:

Phone:

Will you have a Passenger?

Passenger Name: