2018 ALYN Wheels of Love: Israel Charity Bike Event

Wheels of Love 2019

The registration fee is $950 (3,530 shekels). You can save ALYN resources by paying the registration fee online. If you choose call-in, you must call our office within 48 hours for your registration to be approved.

Any questions? Email us at alynactive@alyn.org. THANK YOU.

basic info

riding preferences

Fundraising

secure pay

Please tell us about yourself

X*First Name (English)

X*Last Name (English)

XFirst Name (Hebrew)

XLast Name (Hebrew)

X*Phone

X*Language Preference

X*E-mail

X*Date of Birth

X*Gender

MaleFemale

XPassport Number (for non-Israelis)

XID Number (Teudat Zehut for Israelis)

X*City

XState

X*Country

X*Postal Code

X*Address line 1

XAddress line 2

X*I wish to receive emails from ALYN Hospital and Wheels of Love (must be checked or you will miss important ride updates)

Please tell us your preferences for the ride

X*Route

XSpecial Diet (All meals Kosher Israeli Rabbinut.)

X*Jersey Size (Measure under your arms around the upper part of your chest)

X*Emergency Contact

X*Emergency Contact Mobile Phone

X*Emergency Contact Relationship (Spouse, Parent, etc)

The standard hotel rooms are for 3 people. You can upgrade to a double or a single room. Since the ride begins Sunday morning, you also have the option of staying in the hotel Saturday night and we will take you to the start Sunday morning.

XHotel Saturday Night

XHotel Upgrade (4 nights)

XRoomate Preference #1

XRoomate Preference #2

XI am not bringing my own bike and will need to rent one

You need to approve the previous step to continue

FUNDRAISING

To help you fundraise, we will create a personal fundraiser page for you. Would you like to add a personal message? (250 character maximum)

XAdd Your Personal Message

The minimum fundraising requirements are: $3,000 Off-Road/Enduro, $3,500 On-Road/Touring, $4,000 Challenge, $750 Volunteers.

X*I agree to meet the fundraising requirements for the route I have selected. I understand that if I have not met the requirements, I will have to give a credit card number at ride check-in as a security deposit. If I do not meet the requirements by December 31, 2018, my credit card will be charged to cover the shortfall as a personal donation.

The majority of participants raise more than the minimum. What is your goal?

X*Personal Fundraising Goal (USD). Please use only numbers

AGREEMENTS AND CERTIFICATIONS

X*I certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity.

I have checked the above declaration, but I want ALYN to know that I have the following medical conditions and take the following prescription medications:

XMedications

XMedical condition

X*I have read and agree to the Terms and Conditions of the ALYN Wheels of Love ride

X*I have read and agree to the cancellation policy

Terms and Conditions Cancellation Policy

Parental Consent (participants under 18 years of age must print out this form, have it filled out and signed by parents or guardian, and email it back to us prior to the event.

You need to approve the previous step to continue

Currency

If you have a coupon code please enter it below.

Registration Fee: 1,350

Total Payment: 1,350

Thank you for registering.

Thank you for completing the registration form for the ALYN Wheels of Love ride. We are so excited that you will be joining us on the world’s premier charity bike ride! Please note that you selected the call-in payment option. You must call the following numbers and make your payment within one week to confirm your registration: From US: 1-866-629-0025 — From UK: 0330-828-0808 — From Israel: 02-649-4235 / 4216

Thank you.

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