Motorcycle Ride for Suicide Awareness
Loss Survivor Registration
Your Name
*
Person you loss to Suicide
*
First Name
Last Name
Your Number
*
Your E-mail
*
example@example.com
Short message to your Loved One.
*
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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Accepted file formats: GIF, JPG and PNG
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I understand I’m giving HMCF permission to honor my Loved One.
*
I agree
Additional Comments/Concerns
Signature
*
Submit
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