Name ________________________________________

Address ________________________________________

City ____________________ ST __________

Zip _______________

Pre-Registration  $20/bike;  $5 for passenger

On-Site-Registration  $25/bike;  $5 for passenger

_____  $20/$25 Registration

_____  5 Passenger

_____  $1 for extra prize ticket

_____  $5 for 6 extra prize tickets

_____  $10 for 6 extra tickets & a donation for school supplies for homeless children

_____  I won't be riding, please accept my tax deductible donation

__________ Total

Please make checks payable to:
Emily Ann Griffin Foundation

Print this page and fill out this form

Mail form and check to:
Dan Mrowczynski

15075 Finch Ave

Plymouth, MI 48170

Pre-registration forms should be postmarked no later than 8/17/08