Rider Pre-Registration Form - Payton's Race for a Cure

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Rider Pre-Registration Form

Participation fee is a charitable donation of $25 per rider. Each rider will recieve a goodie bag and a t-shirt the day of the event.

Prizes will be awarded for riders through charitable donations from major sponsors such as One Industries, Shift, Rocky Mountain ATV, Ogio, AXO America, Scott and many more.

Cash or check is appreciated. Please make all checks payable to Payton's Race for a Cure.

* required information


Rider Information
Title:
First Name:*
Middle Initial:
Last Name:*
Suffix/Degree:
Age:*	years old
Gender:*	Female Male
Birth Date:*	(mm/dd/yyyy)
Address Line 1:*
Address Line 2:
City:*
State:*
Province:
ZIP/Postal Code:*
Country:
Phone:*
Email:*
Opt in:	Yes! I would like to receive further information via email about the United Mitochondrial Disease Foundation.

Please fill in the information below. Each rider will recieve one (1) complimentary t-shirt.
Dirt Bike or Quad:*
Make & Model:*
CC:*
Class:*
T-Shirt Size (XS-XL):*