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Stroke Challenge - Challenge Yourself. Challenge Stroke.

2014 TD Bank Five Boro Bike Tour Application

1. Contact Information

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Name:

 

 

   

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City/State/ZIP:

 

    

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2.
Question - Not Required - Birth date (if you are under the age of 18, birth date is required).




*3.
Question - Required - I would like to request a space on National Stroke Association's 2014 TD Bank Five Boro Bike Tour Team. I commit to raise a minimum of $2,000 for National Stroke Association by June 30, 2014. If selected I will receive guaranteed tour entry from National Stroke Association. I understand that I am responsible for completing the fundraising requirement of $2,000 no later than June 30, 2014, and if this minimum is not met by that date my credit card will be charged for the remaining balance due.

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