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Valid Licenses/Certifications please fax a copy with your assignment form to o MD o OT/PT o RMT o RN/LVN/LPN o Chiropractor o Paramedic o Athletic Trainer o Podiatrist o ASL Interpreter 3. 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...
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