Cruise For Cancer Registrations

You are registering for the Cruise For Cancer.

First Name:
Last Name:
E-mail Address:
Phone Number:
Mobile Number:
Fax Number:
Address:
City:
State:
Postal Code:
Registration Type:
Rider's Bike Type:
Rider's Bike Model Type:
Does the bike have a back rest?
Rider's Driver's License State:
Rider's Driver's License Number:
Bike's Number Plate:
Rider's Nickname (optional): eg. Hammer
HOGS Member?
Rider's HOGS Chapter:
Rider's HOGS Membership Number:
Rider's Spare Helmet:
Request a specific pillion (optional):
Pillion's Weight (KG):
Pillion's Height (CM):
Pillion's Age:
Pillion's Gender:
Pillion's Esimated Helmet Size:
Pillion Terms & Conditions Harley Owners Group members will allocate passengers to bikes. Harley Owners Group members have the right of refusal to carry a passenger if circumstances dictate on the day of the Cruise. For passenger comfort and safety, passengers must wear appropriate clothing such as long pants, long sleeve shirt, closed shoes, and suitable jacket. It will be a requirement to sign a disclaimer form covering your participating in "Cruise for Cancer" on the day of the event. I understand and agree to the Pillion Terms & Conditions
Request a specific rider (optional):
Comments (optional):

Privacy Statement: Information supplied will be used to organise the Cruise For Cancer.
It may be disclosed to individuals on the organising committee, and may be delegated
by the organising committee to other Cruise For Cancer volunteers.
It will not be used for any other purpose.

Pillion Terms & Conditions