Casper Cycling Club Charitable Ride Claim Form
Name________________________________________________
Address______________________________________________
Phone________________________________________________
Name of Ride__________________________________________
Date of Ride___________________________________________
Where is the Ride ______________________________________
Charity the Ride is Benefiting, including address to send check_________________________________________________
Ride Entrance Fee_______________________________________
Date Entrance Fee Paid___________________________________
The total amount of money you raised for the charity$_____________
Signature/Date__________________________________________
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Rules:
- A check payable to the Charity will be sent to you prior to the ride.
- The amount of the check will match the amount of money you raised to a maximum of $150.00.
· Send above information to CCC, PO Box 50981, Casper, WY 82605 at least two weeks prior to the ride, or send in all info after ride is complete.
· Sign the statement below upon completing the ride and send to above address.
· When statement below is received you will receive a check for $100.00 toward entrance fee and expenses.
I _______________________________________ (name) have completed
________________________________________________ (name of ride).
Signature/Date_____________________________________
