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Team Care/Tapestry
Sponsor Amount: $
(e.g. 180.00)
Personal Information
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*
Last Name:
*
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*
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*
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*
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Phone Number:
*
Cell Phone:
Email Address:
*
Payment Details
Credit Card
Card Type:
*
Visa
Mastercard
American Express
Discover
OJC
Donors Fund
Card Number:
*
Exp. Month:
*
-- Select One--
01-January
02-February
03-March
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06-June
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*
-- Select One --
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2025
2026
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2033
Security Code:
*
Additional Comments:
Please mail a receipt to the address above
(in addition to the receipt I will receive via email).
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Please add the following comment to the ticker on Team Care/Tapestry's personal page.
(eg: In honor of xxx)
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The 100 Ride is a non-profit 501c3 organization.
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