Registration & Pledge Form
All proceeds go to support adult literacy education in our community!
Rider’s name: _________________________________________________ Phone #: (______) _______ -___________
Address: __________________________________ City/Town: ________________ Prov.:______ Postal Code: _____________
E-mail address: _________________________________________ Passenger’s name: __________________________________
Club/Group (if any): _________________________________ Motorcycle make/model: ___________________ Year: ___________
General Release and Waiver of Liability
I/We do hereby remise, release and forever discharge the Learning Centre for Georgina, the Lake Simcoe Ride for Literacy, the Town of Georgina, the Region of York, the
volunteers, sponsors, hosts, vendors, dealers, manufacturers, contributors and their respective directors, officers, employees, members, agents and representatives from all
losses, expenses, liabilities, manner or causes of action, suits, claims, demands and damages whatsoever, which I/we, my/our Heirs, executors, administrators or assigns can,
shall or may have against them or any of them, for any matter, cause or thing arising from or in connection with any personal injury, including fatal injury, or property damage
that may be sustained or incurred in connection with or relating to my/our participation, use and/or operation of a motorcycle or other vehicle or otherwise in the Lake Simcoe
Ride for Literacy charity motorcycle ride and/or any events associated thereto and whether arising from any negligence or breach of contract. I agree to operate my vehicle in
accordance with the Ontario Highway Traffic Act.
I/We hereby acknowledge that I/we have read, understand and will abide by this Agreement:
__________________________________ ________________________________
(Rider/Fundraiser) (Passenger)
Registration Instructions: Fill this form in completely and bring it to the registration desk on July 19th or mail it to the Learning Centre for Georgina, 90
Wexford Drive, Unit #3, Keswick, Ontario, L4P 3P7 – mailed forms must be posted by July 9th to allow time for processing. Registration fee for each rider
is $40.00 (or a minimum of $40.00 in pledges) and $10.00 for passengers.
Yes! I want to help support adult & youth literacy education!
Make cheques payable to “Learning Centre for Georgina”. Charitable Registration #88875 3795 RR 0001
Please print clearly (Complete mailing address is required if tax receipts are to be mailed.)
RECEIPT?

 Name: ________________________________ Amount: $ _____________ Phone #: (______) _______ - __________
Address: _________________________________ City_________________ Prov________ Postal Code: ___________

 Name: ________________________________ Amount: $ _____________ Phone #: (______) _______ - __________
Address: _________________________________ City_________________ Prov________ Postal Code: ___________

 Name: ________________________________ Amount: $ _____________ Phone #: (______) _______ - __________
Address: _________________________________ City_________________ Prov________ Postal Code: ___________

 Name: ________________________________ Amount: $ _____________ Phone #: (______) _______ - __________
Address: _________________________________ City_________________ Prov________ Postal Code: ___________

 Name: ________________________________ Amount: $ _____________ Phone #: (______) _______ - __________
Address: _________________________________ City_________________ Prov________ Postal Code: ___________

 Name: ________________________________ Amount: $ _____________ Phone #: (______) _______ - __________
Address: _________________________________ City_________________ Prov________ Postal Code: ___________
Donation receipts of less than $10.00 must be picked up at the Learning Centre for Georgina, 90 Wexford Drive, Keswick.
Total this page (CASH) $: __________________ Total this page (CHEQUES) $: __________________
For more information, call us toll free at (877) 779-0888 or visit our website at www.rideforliteracy.com
We appreciate your support of the Ride for Literacy in support of the Learning Centre for Georgina. We treat your personal information with respect. We do not rent, sell or
trade our mailing lists. The information you provide will be used to provide tax receipts, to contact prize winners where applicable and keep you informed of other events and
fundraising opportunities in support of LCG. If at any time you wish to be removed from our list, simply contact us by phone at (877)779-0888 or via e-mail at
info@lcgeorgina.org .