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Children’s Motorcycle Adventure
Request Form
ABATE of Indiana, Inc., PO Box 665, Bargersville, Indiana 46106
800-232-2283 | 317-422-8040 | [email protected]
PLEASE FILL OUT ALL SPACES
Region # : ________
Date of event: ____________________________
County : _______________________________________________________
Person in charge : ______________________ Phone (_____) ____ - ______
Second contact : _______________________ Phone (_____) ____ - ______
Location of event (address) : ______________________________________
________________________________________________________________
Name of event : _________________________________________________
Training complete?
Y
N
Insurance secured?
Y
N
Region Director Approval : ________________________________________
Children’s Motorcycle Adventure
Request Form
ABATE of Indiana, Inc., PO Box 665, Bargersville, Indiana 46106
800-232-2283 | 317-422-8040 | [email protected]
PLEASE FILL OUT ALL SPACES
Region # : ________
Date of event: ____________________________
County : _______________________________________________________
Person in charge : ______________________ Phone (_____) ____ - ______
Second contact : _______________________ Phone (_____) ____ - ______
Location of event (address) : ______________________________________
________________________________________________________________
Name of event : _________________________________________________
Training complete?
Y
N
Insurance secured?
Y
N
Region Director Approval : ________________________________________