2018 Crew Assignment Form

The 2018 Ride to Conquer Cancer is August 25th and 26th

Please note there is an All Crew Meeting on August 24th at 6:00PM.

Please fill in all of the information below and return the form by fax, post or email.

  1. Contact Information: (Please PRINT Clearly)

Name:______Date of Birth: ______
Email: ______
Street Address: ______/ Cell Number: ______
Postal Code: ______
  1. Valid Licenses/Certifications (please fax a copy with your assignment form to 604-684-9296):

o MD / o RN/LVN/LPN / o Athletic Trainer / o Special License (C 3, etc) ______
o OT/PT / o Chiropractor / o Podiatrist / o Acupuncture/Holistic Medicine ______
o RMT / o Paramedic / o ASL Interpreter / o Other ______

3. Weight you are capable of lifting:

o 0 lbs / o 10-20 lbs / o 20-30 lbs / o 30-40 lbs / o 40+ lbs

4. Vehicles you are comfortable driving:

o None / o Van (7 person minivan)
or SUV / o 15 ft. Truck / o 24 ft. Truck / oManual Transmission Truck

5. Assignment Choices: We will do our best to accommodate your choices, but the needs of the event come first.

1. ______
2. ______
3. ______
4. ______

6. Are you interested in being a Crew Captain?o Yeso No

7. Can you provide your own vehicle?o Yeso No

8. Are you available prior to the event as well? o Yeso No

If you are available prior to the event please circle what you are available for:

Friday August 24th: 2:00 p.m. – 8 p.m. (Assisting with Friday check-in/bike parking) o Yeso No

Office Volunteering: Assist with administrative tasks before event. o Yeso No

Route Notification: Notifying a portion of the route via letters/flyerso Yes o No

8. Please indicate your t-shirt sizeS/M/L/XL/XL

9. Do you require a vegetarian meal (this meal is also gluten free)o Yeso No

10. Are you looking to collect volunteer hours/references?o Yeso No

11. Are you a returning Crew Member?o Yeso No

If yes, what was your role last year? ______

12. If there is another Crew Memberyou would like to be with for the event weekend, please indicate the Crew Members name:

______

13. If you have a friend or family member who is interested, write down their name and email. We would be happy to send them some information about Crew.

______

14. Special Considerations: Please list any physical limitations, injuries, allergies, refer a friend etc.

______

______

15. Registration Fee:

Please submit your non-refundable $25 registration fee with this form. If you are submitting a personal cheque please make it payable to: Ride to Conquer Cancer

● Visa● Mastercard● Amex

Cardholder Name

Card Number

Expiry /

Cardholder Signature

Thank you for supporting the Ride to Conquer Cancer!

Email:

Fax: (604) 684-9296

Mail:The Ride to Conquer Cancer

303 – 698 Seymour Street

Vancouver, BC V6B 3K6

Attn: BC Volunteer & Crew Coordinator