Jericho Road Ride - Registration Form

Name
Email
Street Address
Town
State
Zip Code
Contact Phone Number:
What distance will you ride?	10 Miles (Concord to Carlisle) 20 Miles (Concord to Lowell) 40 Miles (Concord to Lowell via Sudbury)
Are you riding as a team member or as an individual?	team member individual
If you are riding as a part of a team, please enter the name of your team and its affiliation with a nonprofit or other group:
Do you expect any family or friends to join you in Lowell? If yes, how many? (for food estimation)
Do you need a ride from Lowell to the start-line?
Do you need post-ride transporation back to Concord?*

Registration fee: Riders are required to raise a minimum of $175 to take part in this event; riders 14 and under need to raise a minimum of only $25. Pledging online is available; see tab above! Other pledges must be handed in on the morning of the ride during registration. All contributions are tax deductible and checks should be made out to the Jericho Road Project-Thanks! Remember that some companies may contribute to match your donation! If you or your supporters would like to do so, you will need Jericho Road's address and our EIN number: 82-0553404.

*Transportation: We can and will transport riders and their bikes from Lowell to Concord as necessary. Our hope is that most of you will have your friends and/or families greet you at the finish line in Lowell and join us for the fun activities there--and then give you a ride home! For more information or questions, call or email Dan Holin at 978-369-9602 x457 or dholin@jerichoroadproject.org.