Cruisin' 4 a Cause - Pay by Check | United Way of Harrison and Doddridge Counties

First Name

Last Name

Email Address

Phone Number

Mailing Address

City

State

Postal Code

Shirt Size

(For participants only)

Name of Passenger

REGISTRATION & SPONSORSHIP

Rider & Passenger Registration

Rider & Passenger - $25.00

Individual Rider - $15.00

-None-

Space filler

Sponsorship Levels

$2,500.00

$2,000.00

$1,000.00

$500.00

$250.00

-None-

Challenger - $ 2,500.00 | Chieftian - $ 2,000.00 | Chief - $ 1,000.00 | FTR - $ 500.00 | Scout - $ 250.00

Total Payment Due: $ 0