Registration

Registration for onemillionbicycles.org Rallies
August 9th 2009

Upon completion, hit SUBMIT to send this registration via e-mail, or print and mail, with check payable to "umbrella" to:

onemillionbicycles.org
2820 N. Willamette Blvd.
Portland, Oregon 97217
(503) 239-6985

Registration is $5.00 per person, plus a pledge to bring a new or used bicycle and/or a new or returning rider with bicycle.

You will periodically receive rally information via email. We will notify you of the nearest rally location to participate, celebrate and be a voice for change!

Registrant Information
*Registrant Name:
Add up to 4 additional registrants below
*eMail address:
*Confirm E-Mail Address:
*Address:
*City: * State:   *Zipcode:
*Phone:
*Number of participants: Amount:
Check at least one: I will bring a new or returning rider with bike
I will Donate a new or used bike
Participant 2 Name:
Participant 3 Name:
Participant 4 Name:
Participant 5 Name:
Payment Information
Payment
Upon clicking the submit button below you will be taken to a confirmation page, at that time you will be given the opportunity to pay your rally entrance fee by credit card or PayPal.
Anti-Spam Verification
Security Image

Please enter the Security Code as above: