Registration Form

The Wisconsin State Firefighters Memorial

Wisconsin State Firefighters Memorial
P.O. Box 248
Wisconsin Rapids, Wisconsin 54495-0248

Honoring those who have made the ultimate sacrifice

Wisconsin State Firefighters Memorial

3rd Annual Motorcycle Ride Registration Form

Name of registrant:_________________________________

Name of rider (if applicable):_________________________

Mailing address:___________________________________

___________________________________

Phone number (day):_______________________________

Phone number (night):______________________________

e-mail address:____________________________________

Amount of check enclosed:__________________________

Make checks payable to: Wisconsin State Firefighters Memorial

Mail completed form to: Wisconsin State Firefighters Memorial
P.O. Box 248
Wisconsin Rapids, Wisconsin 54495-0248

If you have any questions contact: Ron Naab, Motorcycle Ride Chair
Phone: 262-629-9749
Email: rjnaab@nconnect.net

Pre-registered people can go to a special line for their ride packet on ride day.