Registration Form:   

Please print*, complete, sign and return mail this page to register for this years event.


Each rider will receive an event t-shirt, patch and a Guide Dog of America Pin.

Passengers will receive a t-shirt only.


Pre-registration : $15.00 Donation for rider/driver, $5.00 for passenger

Day of ride: $20.00 Donation for rider/driver, $5.00 for passenger



Mail registration form and payment to:


        IAM&AW District 751                         Please Make Checks Payable To: 

        Attention: Puppy Putt                       Guide Dogs of America

        Lori Dorsey

             8729 Airport Rd East

             Everett, WA 98204

*For best printing, select "Shrink To Fit" from your "File, Print Preview" setting.



Name (Rider/Driver): _______________________________________________ Date of Birth: ____/____/____


Address: __________________________________________________________ Telephone: (___)___________


City, State/Province, Zip Code: ________________________________________ Shirt Size: _______________


Motorcycle: Make______________________Model_______________________ Year________ LIC#__________


Email: (optional)______________________________________________________________________________


Web Site: (optional)___________________________________________________________________________



Name (Passenger): _________________________________________________ Date of Birth ____/____/____


Address: __________________________________________________________ Telephone: (___)___________


City, State/Province, Zip Code_________________________________________ Shirt Size: _______________


Email: (optional)_____________________________________________________________________________


Shirt Size: __________________________________________________________________________________



RELEASE OF LIABILITY: I understand that state law requires vehicles and drivers/riders to be appropriately licensed and endorsed and to have their own liability insurance to operate on state roads and highways and that it is my responsibility to provide that insurance. I, therefore, release and hold harmless IAM&AW, District 751 Guide Dogs of America event volunteers, sponsors/supporters, participating merchants and event site owners and personnel from any responsibility for any damage or injury I may incur or cause while participating in this event. I have read this form and agree to the above statement (Signature(s) required).  Minors under 18 must have parents sign for them.


                      _________________________________________     __________________________________________

       Rider/Driver Signature (Required)                               Co-Rider Passenger Signature (Required)


PLEASE NOTE: Pictures taken at our events are for use in only professional publications, promotional materials and on this web site. Pictures taken at this event will and may not be used for distribution or re-sale in any way, shape or form. Participants agree and understand this note.


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