Rider’s Full Name:_________________________________________ Age:_____

Phone:____________________

Address:______________________________________________

City:____________________State: _______ Zip:______________

E-Mail:_____________________________________

Desired T-shirt Size(if you raised at least $30): S M L XL

What is the total dollar amount you are contributing? (you may be eligible for additional prizes) $_____________________

Which route will you be riding?
___KITTEN CRAWL (10 miles) ___SPANIEL STRETCH (27 miles) ___GREYHOUND HAUL (45miles)

How did you hear about Pedal for Pets?____________________________________________

CONTRIBUTERS to your participation (if you wish to commend them):

Name__________________________________________amt.$___________________

Name__________________________________________amt.$___________________

Name__________________________________________amt.$___________________

Every participant must familiarize themselves with the "Oregon Bicycle Manual" found at the website http://odot.state.or.us/. By signing this application, you as a participating cyclist state you have read the Manual and know that you must wear a helmet while riding for Pedal for Pets.

Signature__________________________________________date________________

CHECKS SHOULD BE MADE OUT TO PEDAL FOR PETS, OR PAYPAL PAYMENTS SHOULD BE MADE TO [email protected]. Applications can also be brought with payments to the event on June 15th.