Pre-registration Form

Registration is easy! Just fill out the form and when you are done press send to register at the Lupus Alliance.
Or print this form and mail it to us at: Lupus Alliance of America, Michigan Indiana Affiliate 26507 Harper Ave., St. Clair Shores, MI 48081 or Fax to us at 586.775.8494

 Name:
Address:
City:
State:
Zip Code:
Telephone:
E-Mail
 (if applicable):
Individuals Riding With Me:

  I am riding at Stony Creek Metropark on May 22

  I am riding with a team - Team Name:

  I would like to help with securing corporate donations and prizes for the ride.

Prizes for Participation

Each paid registration will receive a "Ride 2004 T-Shirt. A raffle will be held at the conclusion of the bike ride for valuable prizes. The ride will be fun for everyone so bring your family and friends and join in on the fun!

 

Lupus Alliance of America, Michigan Indiana Affiliate  26507 Harper Ave, St. Clair Shores, MI 48081
Phone: 800.705.6677    Fax: 586.775.8494    Email: info@milupus.org