This is the registration form for the Sierra Moon Shine Poker Run Sept. 8, 2018. Run starts at the Historic Coarsegold Village in Coarsegold. This event is benefiting the Caring Veterans of America, Inc. A local veterans support organization. Funds stay local!

NOTE: IF YOU ARE HERE TO OFFER A DONATION ONLY (AND ARE NOT GOING TO EVENT) PLEASE FILL OUT ALL OF THE REQUIRED FIELDS (SO WE KNOW WHO YOU ARE) THEN ENTER THE AMOUNT YOU WOULD LIKE TO DONATE IN THE DONATION SECTION. THANK YOU!

Rider / Passenger Information

Rider First Name *

Rider Last Name *

Please do not list "Rider" in passenger field. Use only if passenger.

Passenger First Name 🛈

Passenger Last Name

Phone Number *

MC Club name (if any)

Street Address *

City *

State *

Zip Code *

Rider Email address *

Donation Selection

Choose One if going on run. If you just want to donate type amount in box below.

Rider Only ($30.00)

Rider and Passenger ($50.00)

Here's an extra donation for Caring Veterans of America

Please Take A Moment...

How did you learn about this run? *

Please email me future SSC, MC ride information

Credit Card Information

Our Ride Donations are processed by PayPal. Once your form has been submitted you will be forwarded to PayPal where you will then enter in your payment information. You do not need to have a PayPal account to make your payment.

You're almost done! Just click "Continue" below.

THANK YOU FOR PARTICIPATING IN OUR RIDE!

The SSC, MC

Please do not list "RIDER" in passenger field