15th Annual Law Enforcement Benefit Ride

Pre-Registration Form & Release

www.benefitride.com

I fully understand that operating motorcycles may be hazardous.  By signing below, I release the organizers of this event, the Ricky J. Parisian Foundation, and the New York State Police from any liability while participating in the 15th Annual Law Enforcement Benefit Ride.  This release further applies to any passenger that accompanies me.

Signature:__________________________

PRE REGISTRATION INFORMATION (please print)

Name:__________________________

Mailing Address: __________________

                         __________________

                         __________________

Number of riders _______ x $20.00 each = $________

SHIRT ORDER:

Place the number of T-Shirts you want in the appropriate size and multiply.

15th Annual LEBR Long Sleeve T-Shirt

_____Medium _____Large _____XL _____XXL x $20.00 = ______

Make Checks Or Money Orders Payable To:  Law Ride

PO Box 770

Oneonta, NY  13820

PAYMENT MUST BE INCLUDED WITH THIS APPLICATION

YOU CAN GET MORE COPIES OF THIS APPLICATION ON THE WORLD WIDE WEB AT:

The Ride is scheduled for August 4, 2012 and departs promptly at 11:00 AM from the State Police Barracks in Oneonta, NY, (Exit 13 - Interstate 88).