Registration — YSR DAIZE

Fill Out The Form Below to Register for the event.

Registration Includes - 1 T-Shirt (Please Provide Size Below), 5 raffle Tickets (Additional Raffle Tickets can be purchased at $5 each, or 5 tickets for $20, 10 tickets for $30), and a surprise gift.

Registration Price $55.00 Prior to Event- Week Of Event Price goes to $65.00

Name

First Name

Last Name

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Bikes Bringing Down (Manufacture/Model)

Phone Number

Emergency Contact Info

T Shirt Size (One Is Included in Registration Fee)

Additional Raffle Tickets

Please Select if you want extra raffle tickets. $5 per ticket or 5 tickets for $20, 10 tickets for $30.

Total Amount Sending

Registration Price before June 30th $85.00 after June 30th Prices go up to $95.00 + ADDITIONAL RAFFLE TICKETS IF APPLYS

Payment

Payments For Event Can Be Sent Via PayPal (Friend & Family) to Gotleakz21@aol.com. Please put your PayPal Email Below In Description please Put Your Name. (NOTE YOU WILL NOT BE CONSIDERED REGISTERED UNTIL PAYMENT IS RECEIVED AND CONFIRMED) If you want additional raffle tickets please make sure to add the dollar amount to the registration amount.

Checkbox

Terms of Agreement

I agree to the terms of conditions (Non Refundable Registration)

I Agree to ride safe and responsible and to respect others (There is a zero tolerance policy with respecting each other)