2023 Ride for Dragonfly Registration and Sponsorship Form

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REGISTRATION NOW CLOSED, please register at the event! We can't wait to see you today!

Join us at Queen City Harley Davidson on August 26th for the 6th Annual Ride for Dragonfly

presented by The Basement Doctor

If you prefer to pay by check, please email a.brokaw@dragonfly.org.

Payment can be mailed to The Dragonfly Foundation at 506 Oak Street, Cincinnati, OH 45219.

All makes and models are welcome!
Register before August 7th and receive a free t-shirt
This is a DRY RIDE until kickstands are down at Queen City Harley-Davidson in West Chester, OH.
No colors, please.
WAIVERS & MINORS
If you would like to purchase a t-shirt, please email Ally Brokaw at a.brokaw@dragonfly.org. Short sleeve shirts are $15. Long sleeve shirts are $20.

Registrant/Sponsor Information

First Name

Last Name

Company Name (if applicable)

Street Address

City

State

Zip Code

Work Phone

Mobile Phone

Please use hyphens, not periods or slash marks

REQUIRED: Are you a RIDER or a BLOCKER? Blocker must 3+ years experience

RIDER REGISTRATION - NOW CLOSED, Please register at the EVENT (ALL MAKES WELCOME!)

Number of Bikes with One Rider ($20)

Number of Bikes with 2 Riders ($25)

SUBTOTAL: RIDER REGISTRATION

Sponsorship Opportunities are NOW CLOSED

SPONSORSHIP

SUBTOTAL SPONSORSHIP

NEXT: Payment Information

TOTAL: REGISTRATION & SPONSORSHIP

REGISTRATION SUMMARY

Sponsorship Cost

Single Rider Registration ($20/each)

Double Rider Registration ($25/each)

TOTAL

Payment Information

Name As It Appears On Card

Card Number

Code