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Alyssa's Ride Spring Registration Form 2011
please print copy

Ride Date:
May 19, 2012
Starting Location:Harley Davidson of Cartersville
Cartersville,Ga.  

Drivers Name: ________________________________________T-Shirt ( S M L XL XXL )tshirt only to the first 50 riders

Address:__________________________________________________________

City, State, Zip:____________________________________________________

E-mail:__________________________________Phone:___________________

Would you like to receive future notices of Alyssa’s Ride events: Yes / No

Passengers Name:__________________________________________________

E-mail:__________________________________Phone:___________________

Would you like to receive future notices of Alyssa’s Ride events: Yes / No

Release Info:

I understand that Alyssa’s Ride volunteers can not resume responsibility for any aspect of safety of my self or passenger, and that if I participate in this event I do so voluntarily, on my assessment of my abilities, The condition of my machine and its ability to perform are solely my responsibility. I certify that I am duly licensed and competent to operate a motorcycle in a safe manner for the safety of myself , My passenger, and the safety of others.

I further understand That I assume all risk for my self and passenger and my property. And as the undersigned ,I Give this release and waiver for myself, heirs and successors and representatives. I agree to release and hold harmless Alyssa’s Ride, all of it’s volunteers, helpers, and anyone who is associated with this event. From any and all liability, loss, damage, cost of claims, lawsuits, or cause of action including but not limited to all bodily injuries, including death, and property damage, arising out of any aspect of my attending at or participation in this event. No matter whether on the premises where the event is being presented or while preparing for the participation in any activity associated with this event.

Payment Type:
Check:_________. Please make check payable to Alyssa Leonard
Mail to:
Alyss's Ride Foundation
P.O. Box 61 Taylorsville, Ga. 30178
Credit Card______
Type, M/C or Visa  ( Please cirule one )
Name on Card _________________________________________________________________________
Address______________________________________________ State___________ Zip______________
Account #____________-______________-_______________-_______________
Expiration Date________Month____________Year_____________
CVC#______________( 3-Diget on Back of Card )
Amount approved to be deducted from your account $______________
Sign_______________________________________Date___________________
Please mail Signed Registration form along with payment to:
payable to ALyssa Leonard
Alyssa's Ride Foundation
P.O. Box 61, Taylorsville, GA. 30178

Alyssa’s Ride May 7 2011

Alyssa’s Ride Against Childhood Cancer

Little Cancer Warrior and Her Army Ride

Taking a Ride against Childhood Cancer....Raising Awareness .. COME JOIN THE ARMY and Help Alyssa fight her battle...she can’t do it alone

May 7 2011

website and info : www.alyssasride.com

starting @ Harley Davidson Of Cartersville Ga.

Address :2281 Hwy 411 NE

Cartersville, Ga.

Ending @ Los Reyes

Address: Joe Frank Harris Pkwy

Cartersville, Ga.

Riders $25. contact numbers : Angela Leonard 678-873-4275

passenger $5. John Leonard 678-873-4273

t-shirts available Kazzi Leonard 678-372-7997

Alyssa is a 12 year old little girl fighting with a brain tumor. daughter of John and Angela from Taylorsville Ga.

Motorcycle Ride register starts @ 9:30am

Ride leaves from Harley Davidson Of Cartersville @ 11am

Ends @ Los Reyes

Cartersville Ga.

If you don’t Ride please come join us @ Los Reyes for Fun and show your support ! time @ Los Reyes 12 noon

Benefit for Alyssa Leonard and helps off set some of her medical expenses all proceeds go to Alyssa.

All donations Welcome : Big or small

Donations can be made @ Bank Of The Ozark in Cartersville, Ga. or mail to Alyssa Leonard
payable to : Alyssa Leonard

PO BOX 61 a online fund has been set up for Alyssa

Taylorsville, Ga. 30178 donations can be made online @ www.giveforward.com/alyssaleonard

Help Support Alyssa With Her Fight