Firehouse Run Charity Ride

Rider Name (*required)

Your Email (*required)

Address Line 1 (*required)

Address Line 2

City (*required)

State (*required)
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Zip Code (*required)

Phone Number (*required)

Type of Ride
Solo2-UPTrikeSidecarChopper

Co-Rider's Name

T-Shirt Size (Adult Sizes Only) (*required)
Select oneSmallMediumLargeX-Large2X-Large3X-Large4X-Large5X-Large

T-Shirt Size for 2nd Rider (Optional - Extra Tees $15 Ea.)
Select oneSmallMediumLargeX-Large2X-Large3X-Large4X-Large5X-Large

Payment Preference (*required)

If you want to pre-pay by Credit Card, select the Credit Card option below and we will email you an invoice to the email address provided above.

I will pay by Cash or CheckI will pay by Credit Card

I understand that this ride occurs rain or shine.

I understand that by submitting this form that I, and any rider/guest with me, agree to hold harmless the Comporium Pioneers, the co-sponsoring organizations, and any property owners for any loss or injury to self or property in which, I/We may have become involved by reason of participation in this run.