| Name: |
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| Street Address: |
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| City: |
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State: |
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| Zip: |
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| Email Address: |
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| Names of those you are registering: |
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| Description |
Unit Price |
Quantity |
Total |
| Early-Bird Registration |
$50.00 |
|
|
| Pre-Registration |
$40.00 |
|
|
| Standard Registration |
$20.00 |
|
|
| Memorial Run Pin |
$5.00 |
|
|
| Street Glide Raffle Tickets |
$10.00 |
|
|
| Grand Prize Raffle Tickets (for pre-registered riders only) |
$10.00 |
|
|
| Saturday Meal Tickets (w/ soft drink) |
$10.00 |
|
|
| Bike and Car Show Entry Fee |
$20.00 |
|
|
| Grand Total |
|
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| Please select a method of payment |
|
Check:
Please make your check payable to "Sacramento Law Enforcement Memorial Run" or "SLEMR." |
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Credit Card:
|
Visa |
|
MasterCard |
| Card #: |
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| Name on Card: |
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| Expiration (mm/YYYY): |
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| CVV(3-digit number on back): |
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