Name ______________________________________________________________ Age _________________________

Address _________________________________________________________________________________________

City ____________________________________________________________________  State ______  Zip _________ 

Phone __________________________________ Email____________________________________________________

How did you hear about Emerald City Lights Bike Ride  Flyer Magazine Radio Bike Expo Friend Previous Ride Website Other

I wish to participate in this fundraising event which I understand to be a non-competitive walk (each such walk being hereinafter referred to as a ("Walk") and related events and activities including but not limited to training walks (the "Event").  I understand that by participating in this Event, I will be using public streets and facilities where many hazards exist and I am aware of and appreciate the risks, which may result.  I am also aware that accidents occur during walking events such as this, both while walking and while not walking, and that I may be seriously injured as a result.  I am voluntarily participating in this Event with knowledge of the dangers involved and I agree to accept any and all risks of injury.

Make check or money order payable to Emerald City Lights, PO Box 872, Auburn, WA  98071

After registering with PayPal/Credit Card - Print information Form above and send to email address

E-mail info@emeraldcitylightsbikeride.org or contact us at 253-709-1530 or 253-735-4982

You May Order your Emerald City Lights T-Shirt 

for $10 with Your Registration or at the Event (depending on availability)

Sizes:       S      M      L      XL

Register with PayPal or on Active.com

Register for 5K Walk:  January 1, 2009 to September 4,  2009 $15.00

Register for 5K Walk On Day of Event at Game Farm Park -   September 5, 2009 $20.00 (Check or Cash)

BACK to