End Polio Now Trail Ride
             
Presented by:  The Richfield Rotary Club
with all proceeds going to Rotary International's End Polio Now Initiative
June 7th - June 9th, 2018

For more information please contact Brent Thorne 435-979-0852
Or see the Event Flyer



 
Participant Registration (Please enter the number of Participants for each registration type)
3-day Registration:   $120.00   Quantity:   Item Subtotal:  
$0.00
Participants Full Name [1]

Participants Full Name

[2]

Participants Full Name

[3]

Participants Full Name

[4]

Participants Full Name

[5]

Participants Full Name

[6]

Participants Full Name

[7]

Participants Full Name

[8]

Participants Full Name

[9]

Participants Full Name

[10]
1-day Registration:   $60.00   Quantity:   Item Subtotal:  
$0.00
Participants Full Name [1]

Participants Full Name

[2]

Participants Full Name

[3]

Participants Full Name

[4]

Participants Full Name

[5]

Participants Full Name

[6]

Participants Full Name

[7]

Participants Full Name

[8]

Participants Full Name

[9]

Participants Full Name

[10]
 
Dutch Oven Dinner (Friday, June 8, 2018)
Dutch Oven Dinner Tickets (12 and older):   $15.00   Quantity:   Item Subtotal:  
$0.00
Dutch Oven Dinner Tickets (under 12 years):   $10.00   Quantity:   Item Subtotal:  
$0.00
 
Total:
$0.00
 

Contact Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone: Email:
 
Please read the following and check the box below.

All participants understand that riding ATVs and UTVs may be hazardous and agree to accept full responsibility for their own personal safety and well-being. Riders and participants must carry their own medical/accident insurance and agree to hold harmless and indemnify the Richfield Rotary Club, "End Polio Now" Trail Ride, its officers, and all sponsors, contributors, land management agencies, guides, volunteers, and any others who help organize, sponsor, or carry out this event from any claims, injuries, or liabilities caused or created by participating in any way in this event.

I understand that the Richfield Rotary Club, "End Polio Now" Trail Ride is a guided ride event.  If I choose not to participate in a guided ride or choose to leave a ride early, I agree to take full responsibility for my well-being and the well-being of any and all passengers on my machine.  I also agree to hold harmless Richfield Rotary Club, "End Polio Now" Trail Ride and its sponsors and volunteers in case of accident resulting in injury, death or equipment damage.

 
Participant(s)
I have read and agree to the statement above.

Payment Information
Method of Payment:
Convenience Fees: Credit cards: 2.9% plus $0.30
eChecks: $0.55
Update name from Contact Information
Name of Individual
on Checking Account:
Name of Individual
on Savings Account:
Name of Business
on Checking Account:
Bank Routing Number:
Bank Account Number:
Credit Card Number:
Expiration Date: /
Card ID (CVV2/CID) Number: What is the Card ID?
Cardholder Information (exactly as it appears on your statement)
  Update from Contact Information
Cardholder's Name:
Billing Street:
Billing ZIP/Postal Code:
Use Instant Payments to accept payments for your business.
SIP Program & Data © 2006-2018 Instant Payments All rights reserved.
~ Terms & Conditions ~ Privacy Policy ~ Contact Us ~
Version 2.15; API: 2.4
Get Help RSI Security Instant Payments, Payment Processing Service, Clinton, UT