Motorcycle Ride for Suicide Awareness
Loss Survivor Registration
Your Name
*
Person you loss to Suicide
*
First Name
Last Name
Person you loss to Suicide
*
Year of Birth
Year of Resting
Your Number
*
Your E-mail
*
example@example.com
Please include one (1) recent pic of your Loved One that we may use to honor their life at this event. By uploading this image, you declares that you own all rights and permissions to this image, and grant us unlimited promotional use to market your presence at this event..
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I understand I’m giving HMCF permission to honor my Loved One.
*
I agree
Signature
*
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Pic in the Park
Photo of our loved ones lost to suicide will be displayed in the park as a tribute to their memory.
$
25.00
Credit Card
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