This is the registration form for the Sierra Moon Shine Poker run Sept. 17, 2016. Note: This run is the rescheduling of the "Next Firefighter Up" Poker Run which was rained out on April 9, 2016. If you preregistered for the April run it is not necessary to register again if you did not use your registration on the Sierra Memorial Run in June. This event is Benefiting the Yosemite Lakes Park & Coarsegold Volunteer Fire Departments.

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 *

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 ($25.00)

Rider and Passenger ($40.00)

Here's an extra donation for the Volunteer Fire Dept.

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