Registration Form
Sean Ashley Tour D Autism 2011
Saturday, August 6, 2011
New Waverly ISD Sports Complex9452 Highway 75 South New Waverly, Texas
You may register online at Active.com or print and mail this form to the address below.
  • Early Bird Entry Fee*                    $35.00
  • Late and Day of ride Entry Fee**  $40.00
  • Donation                                      $________
                                                  TOTAL $ _________
                        
Make Checks payable to The Sean Ashley House and mail it with this form to listed address below.
Check Number: _______________

Name:_______________________________________
Address:_____________________________________
____________________________________________
____________________________________________
Phone:_______________________________________

Signature:_______________________________________________

*Early Bird Fee postmarked Before July 20th
**Late Fee Due after July 20th.
Online Registration Closing Date:
August 3, 2010 @ 5:00 PM

5606 Parkersburg Drive
Houston, TX 77036
Phone: 713-667-6460
Fax: 713-667-6470
E-mail: sahtourdautism@seanashleyhouse.org