Mercer County Fallen Heroes Memorial Run

P.O. Box

(724) 866-3125 

Rider: _____________________________________________________

Phone: _____________________________

Address: ___________________________________________________

___________________________________________________

Passenger: _____________________________________________________

Phone: _____________________________

Address: ___________________________________________________

___________________________________________________

Riders Signature: _____________________________________________

Passengers Signature: _________________________________________

Date of Event: June 4^th 2011

(First 50 To Pre-Register By May 15^th 2011 - Receive A Free Run Patch)

Pre-registration send form along with payment to address above:

(Check or Money Orders Only)

Disclosure

At no time will either the rider or passenger hold (                   ) and /or Mercer County Vets Motorcycle Association legally responsible for any accident incurred during course of Memorial Run or any other activities that are directly related to same Memorial Run or events that day. It is further noted that inappropriate conduct by either riders and/or passengers is subject to removal from Memorial Run or other activities during day. Removal or denial to participate during all activities during the day is at our discretion.