Website of the Maine Hospice Council and Center for End-of-Life Care

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Maine Hospice Event

Individual and Team Member Registration form

To register, complete this form and click 'Submit.'  All individuals and teams registered by August 8, 2008 will have their names posted on the "Online Pledge Form." Also, all individuals and team member registered by August 8 will receive an event T-shirt. Participants will be notified by email when on-line pledges are received.

Registration:  All participants please complete a registration form. If you are on a team, select which team from the drop-down box. Team Captains, please complete the Team Registration form which is also your individual participant registration.

Name

Registration Type

Individual  ($25 registration fee)   Team Member (select team below)

Team Name

Event

50 mile trek (depart at 8:30)  75 mile trek (depart at 8:30) 25 mile trek (depart at 10:30)
Teams must check-in and depart at the same time. Please do not include 25 mile riders on a 50 or 75 mile team (or visa versa).

Address

City, State, Zip

   

Daytime Phone

Email

Registration confirmations are sent by email. Please provide an email address to receive confirmation.

Emergency Contact
THIS IS REQUIRED

Event T-shirt (registration must be paid by August 8)

Adult Medium Adult Large   Adult Extra Large

Registration Fee:
$25 Individual

Registration fee is due at time of registration and may be paid by check or credit card.  Please select your payment method:
     I'll pay using PayPal   (Click the 'PayNow' button on the previous page after clicking 'Submit' below)
     I'll call 1-800-438-5963 and pay using my Visa/Mastercard
     I'll mail my check made payable to "Maine Hospice Council" to PO Box 2239, Augusta, ME 04338-2239
     I'm a team member - my registration fee is already paid

Pledge Goal

$   $100 Minimum per participant (teams may average their total pledges to achieve $100 per team member)

PLEASE do not send pledges with your registration. Keep collecting until ride day!

Agreements
Please check both

 I agree to wear a helmet.
I agree to sign a "Liability Release Form"