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Frozen Fools Challenge Form

If you would like to participate in the Frozen Fools Challenge and/or sponsor a participant,

or to make a donation,

please complete and submit the form below

Note: Pledges/Donations will be accepted through 4/1/17

The deadline to accept the challenge to ride is 1/7/17.

PLEASE NOTE: Riders* are also required to accept the terms of the Janesville Velo Club Waiver and Release of Liability.

I would like to*
Your Name*
Your Mailing Address*
City*
State*
Zip Code*
Phone Number*
E-mail Address*
Please select the type of sponsorship for your donation*
Name of the rider you are sponsoring
NOTE: No name is needed if you are sponsoring the Group Total or Group Average ~OR~ are making a donation that is not related to the amount anyone rides
Amount pledged per day ridden*
NOTE: Please select "None" if you will be making a donation that is not related to the amount anyone rides
Days Pledge Comments
Amount pledged per mile ridden*
NOTE: Please select "None" if you will be making a donation that is not related to the amount anyone rides
Miles Pledge Comments
Maximum pledge / Donated amount
NOTE: Please use this space to list the maximum amount of your pledge ~OR~ the amount of your donation if you will be making a donation that is not related to the amount anyone rides

Note: * indicates required information.

 

Michael's Cycles  |  2716 N. Pontiac Dr, Janesville, WI 53545  |  (608) 752-7676  |  Email | Site Map

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