Participant: 

Address:     

City:                   State:          Zip: 

Motorcycle Club:      Can help with Road Captains

E-mail Address:    

Phone Number:    

  Bike Show Entry: $5.00 additional entry fee.

Class:   Cruiser Sport Custom

By completing this form the participant hereby releases Shriners St. Louis Convention 2008, Inc., Moolah Shrine Temple its staff, sponsors & vendors of any and all liability during or after the Motorcycle Ride.  Shriners St. Louis Convention 2008, Inc. and Moolah Shrine Temple reserve the right to photograph, and videotape or reproduce on any medium for further use the event at no compensation to participants.  Any participant entering this event surrenders all claims.  Shriners St. Louis Convention 2008, Inc. and Moolah Shrine Temple reserve the right to remove anyone from the premises on the basis of objectionable behavior.

Make checks payable to "Shriners Hospital Ride"
Mail to:  Shriners St. Louis Convention 2008, Inc., 555 St. Louis Avenue, Valley Park, MO 63088

"Net proceeds benefit Shriners Hospitals For Children"

  I Agree to the above Terms & Conditions

ROAD CAPTAINS?  We need your help.