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REGISTRATION
Motorcycle Ride & Poker Run
Pre-Registration Appreciated
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Name:_____________________________________________
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Address:___________________________________________
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__________________________________________________
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City:______________________
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State:____________
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Zip:______
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Phone: (____) _____-________
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*Rider
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$20x______=
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$__________
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Passenger
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$10x______=
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$__________
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T-Shirt (S)
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$10x______=
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$__________
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T-Shirt (M)
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$10x______=
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$__________
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T-Shirt (L)
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$10x______=
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$__________
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T-Shirt (XL)
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$10x______=
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$__________
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T-Shirt (XXL)
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$12x______=
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$__________
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T-Shirts are
By Preorder
Only
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Total =
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$__________
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Make checks payable to:
Dan Stitt IV Memorial Fund
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Mail registration and checks to:
Daniel E. Stitt, IV
Memorial Scholarship Fund, Inc.
336 Arnold Avenue
Leeper, Pennsylvania 16233
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Questions?
814-744-5434 or
hstitt@verizon.net
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*PLEASE NOTE: Riders who pre-register by June 12th can
deduct $3.00 from their rider cost.
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