MS 150 Bike Tour August 11-12, 2002 Albuquerque to Mountainair, NM (and return)

Name______Address______City______State______Zip______Home Phone______Work Phone______E-Mail______Date of Birth______Sex______Employer______

My personal fund raising pledge is (minimum amount to participate is $200): _____Millennium Circle ($2000+) _____Tour of Champions ($7500+) _____Mission Possible ($3500+) _____Other $______I would like help with my fund raising efforts. Please call me. _____My company has a matching gifts program.

T-Shirt Size _____M _____L _____XL _____XXL

Will you be riding as part of a team? _____Y _____N Team Name______Name of Company/Org______Team Captain______Team Type _____Friends/Family _____Corporate _____Club/Org _____School _____Church

_____I plan to ride the 150 mile course _____I plan to be "sagged" for part of the ride _____I plan to ride the “Century Loop” on Day 1 _____$35 Registration Fee before August 1, $40 Registration Fee after August 1 _____$40 Veteran Jersey Fee (3 or more years participation in the MS 150 Bike Tour)

Payment Type: ___Check ___VISA ___MC Exp. Date______Authorization Signature______Card #______Name as it appears on card: ______First MI Last

MS 150 OPPORTUNITIES - Individual _____Send me information on volunteering before the tour _____I am unable to ride but enclosed is my contribution _____I am unable to ride but would like to volunteer the weekend of the Tour

National MS Society, 2021 Girard, SE, Suite 201, ABQ, NM 87106 PHONE: (505) 244-0625 FAX: (505) 244-0629 For more details: http://www.home.earthlink.net/~maserabq/mstourNM.html