First name:           Last name:

Phone Number   Email Address

Street Address:   City State   Zip

Emergency Contact   Emergency Phone # 

 

Step Two: Ride Information

Which tour have you chosen to ride?  5 K. 25 K. 50 K. 100 K.

 

Step Three: T-Shirt Information

Shirts will be available the day of the event, but quantities may be limited.

It is requested you pre-order to prevent delays. Extra shirts may be purchased for $10.00 each.

 

Size and quantity of shirts:   Youth Sizes:   10-12 0 1 2 3 4 5 6 7 8 9 10    14-16 0 1 2 3 4 5 6 7 8 9 10

Adult Sizes:   Small 0 1 2 3 4 5 6 7 8 9 10    Med  0 1 2 3 4 5 6 7 8 9 10   Large 0 1 2 3 4 5 6 7 8 9 10     XLG  0 1 2 3 4 5 6 7 8 9 10

NOTE:  Oversize shirts cost additional $2.00.  Adult 2XLG  0 1 2 3 4 5 6 7 8 9 10   Adult 3XLG 0 1 2 3 4 5 6 7 8 9 10

 

Use Comment Section to enter extra rider's names and shirt sizes, amount of payment,

and comments or special instructions you have.

 

Step Four: Payment  

Please select Payment Type:          PayPal       Check      Note: Do not send Cash 

 

Every participant releases "The Lighthouse" and all volunteers from any/all liability due to personal injury or property

damage associated with this event. All participants acknowledge there are inherent dangers involved with sporting events. 

Lighthouse Ministries is not responsible for any damage to property incurred during this event.

Signature:  _________________________________     Date:  _______________________

                 OR JUST     

If you print, send registration form with payment to: 

The Lighthouse, P.O. Box 5375, Mayfield, Ky. 42066

If registering on line, after you submit, Click to go to  PayPal  Link