Champ Ride 2008
Be A Champ.
Do The Ride.
Rider Registration Form
THANK YOU!

Thank you for registering for Champ Ride 2008! Your contribution in the fight against HIV/AIDS will enable Vermont CARES to continue to provide the necessary programs and services for Vermonters living with and at risk of HIV/AIDS.

Champ Ride ‘08
Saturday June 14, 2008
Kingsland Bay
State Park
North Ferrisburg, VT

Distance Check-in Time Start Time
100 Mile 6:30AM 7:00 AM
70 Mile 7:00AM 8:00AM
50 Mile 8:00AM 9:00AM
25 Mile 9:00AM 10:00AM
12 Mile 9:00AM 10:00AM


Champ Ride ‘08
Vermont CARES
P.O. Box 5248
Burlington, VT
05402

Questions?
Contact Peter Jacobsen,
Executive Director,
at Vermont CARES:

1-800-649-AIDS or
emily@vtcares.org

Information About You

Rider's Name:
Address:
City: State: Zip Code:
Phone: Email:
Does your employer have a matching gifts program?
YES NO
If YES, please provide details

Hey, my friend wants to Do The Ride too!
Rider's Name:
Address:
City: State: Zip Code:
Phone: Email:
Does your employer have a matching gifts program?
YES NO
If YES, please provide details

I Plan To Ride
12 Miles 25 Miles 50 Miles 70 Miles 100 Miles

My personal fundraising goal is...
$2,001+
$1,500-2000
$1,000-1,499
$501-1,000
$250-500
$50-250

Payment Method
I am registering as an INDIVIDUAL
I am registering as part of a TEAM

Team Name:
Team Captain:

T-shirt size: _____Small _____Medium _____Large _____X-large _____XX-large

Registration Fee:
Adult Registration Fee(17 and older)--------------$35

(Note: The Adult Fundraising Minimum is $100 in addition to registration fee.)

*NEW* Non-Fundraising Registration fee----------$75

(Note: Additional fundraising optional)

Child Registration Fee (16 and younger)---------$15

(Note: Fundraising for children is optional)

Please make checks payable to: Vermont CARES’ Champ Ride 2007

Please charge my: VISA M/C

Card Number:
Expiration Date:

Waiver & Release

I am voluntarily participating in Champ Ride 2008 and understand that I will be using public roads and facilities where hazards may exist; I am aware of the risks that may result. I acknowledge the dangers involved and agree to accept any and all risks of personal injury to myself. I acknowledge that I am solely responsible for my personal health & safety and the condition of the bicycle I will be riding. Therefore, I hereby waive all claims against Vermont CARES employees, volunteers or event sponsors for any injury I might suffer while participating in this event. In addition, I understand that my photograph may be used for future Vermont CARES’ promotions.

I have carefully read this Waiver & Release and fully understand it’s contents.

____________I accept terms of Waiver & Release