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Oct. 10-14, 2010, in Israel  
  


 


Register for Courage in Motion

Registered riders commit to raising $2,500 for the Courage in Motion Bike Ride benefitting Beit Halochem.  The ride will take place in Israel on Oct. 10-14, 2010.

Please complete the form below.
* = required

* Name:
(Courtesy Title)
* E-mail:
* Address:



* Phone:

* Gender:
Female Male
* Date of Birth:
(MM/DD/YY)
I represent and warrant that I will be at least 16 years old at the time of the event.
* Passport:


(MM/YY)

Please Tell Us:
How did you hear about the Courage in Motion bike ride?
* Jersey Choices:
Please indicate size preference for 2 bike jerseys, using these sizes. (The jersey sizes reflect typical North American bicycle jersey sizing.)

* Jersey No. 1:

* Jersey No. 2:

* Route Choice:

I am interested in participating in the following route:
Touring Route:  50 - 70 km daily
Challenge Route:  100 - 125 km daily

Off Road Route (minimum of 10 riders required)

Note: This is for our planning purposes. Once specific route details are available, we will ask you for a route commitment.

* Meals:
Do you require vegetarian meals? (Y/N)
* Waiver:
Prior to submitting your payment, please carefully read the Courage in Motion Cyclist waiver:



(Or, open Waiver in separate window. )

I agree with the terms and conditions of the waiver.
* Method of Payment:
Please complete your billing information to pay the $550 registration fee.

Payment method:
VISA MasterCard


(MM/YY)

You will not be considered a registered participant until you have completed this form, paid the registration fee, and submitted your medical waiver. Once you submit this online registration form, you will receive a link through which you can download the medical form.

Beit Halochem will notify you when you are officially registered.

For information, contact courageinmotion@beithalochem.ca.

For complete information about Beit Halochem Canada,
please visit www.beithalochem.ca

 

 
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