Print and Mail
Name:____________________________________ Phone______________________
E-mail address_______________________________________Fax_______________
Mailing Address________________________________________________________
Number to reach me on weekends_______________________________________D/O/B________________
1.) I am ___an avid Cyclist ___a beginner rider ___ occasional rider
2.) I ___ am aware of Autism ___know Autism well ___Love to ride for a cause
3.) I intend to ride ___25 miles or less ___around 50 miles ___the longest route
4.) I intend to ___participate in fundraising ___Just pay my registration fee and ride
5.) I prefer to be notified via ___phone ____email ____mail ____fax
6.) How did you hear about the Mansion Ride?________________________________
The most important aspect of any ride is____________________________________
_____________________________________________________________________
_____________________________________________________________________
Your signature below sets forth the understanding and agreement of our Mansion Ride waiver. Your registration will be returned to you without your signature below.
I agree to follow all the rules set forth by Mansion Ride, and have read and agree to the on line rider Mansion Ride waiver below holding harmless all rest areas, corporations, sponsors, organizers, volunteers, Ascent School, and all other locations and persons affiliated with the Mansion Ride.
Enclosed is my $50.00 off line registration fee.
Signature__________________________________________*Date_____________
Checks should be made out to Ascent: A School for Individuals with Autism
and sent c/o Linda Finkel, Mansion Ride Co-chair
3412 Bayfield Boulevard, Oceanside, New York 11572
Be sure to check the Mansion Ride web page for up to the minute changes. Be sure and press Control and F5 to refresh each page for full updates.
Ride to
Enjoy the sights
Smell the Flowers
Uncover Autism
Build Awareness
& Tell the World
There is Hope!