BellRinger Weekend 2024 — October 25-26

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Student Registration

BellRinger is a bike ride and community movement to end cancer with Georgetown University’s Lombardi Comprehensive Cancer Center. Join us as a student Rider or volunteer for our third annual Ride on October 26, 2024. Fill out this quick form and we’ll get you squared away.

How would you like to participate?

Rider
Volunteer

Student Rider

Student Volunteer

How far do you plan to Ride? *

25 Miles — Washington, D.C. to Glen Echo, MD
I commit to raise $500 for cancer research
50 Miles — Washington, D.C. to Urbana, MD
I commit to raise $625 for cancer research
100 Miles — Washington, D.C. to Urbana, MD
I commit to raise $750 for cancer research

Rider: Personal Information

What is your Georgetown email address? *

Name *

First

Last

Phone Number *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Birthdate *

Gender *

Man
Woman
Non-Binary
Prefer Not to Answer

Unisex Apparel Size *

Gender-Specific Apparel Size *

Rider Type

I am a Survivor
I am a Cancer Researcher

Emergency Contact

Emergency Contact Name *

First

Last

Relationship *

Emergency Contact Phone Number *

What Team would you like to join

Will you need a rental bike to use on BellRinger Weekend? Helmets will be provided with rental bikes. We'll contact you to set everything up. *

Yes
No

What is your height? *

Disclaimer: If you selected yes to needing a rental bike, please complete question.

Participant Waiver, Release of Liability, & Assumption of Risk *

I have carefully read this Participant Waiver, Release of Liability, & Assumption of Risk. I understand and agree to the terms laid out in the Participant Waiver, Release of Liability, & Assumption of Risk.

Volunteer Participant Waiver, Release of Liability, & Assumption of Risk (copy) *

I have carefully read this Volunteer Participant Waiver, Release of Liability, & Assumption of Risk. I understand and agree to the terms laid out in the Volunteer Participant Waiver, Release of Liability, & Assumption of Risk.

Student fundraising commitment *

I understand my student fundraising commitment must be met by 11:59 PM on October 23, 2024. My fundraising commitment is considered satisfied when the “funds raised” number on my Rider Profile page on the BellRinger website meets or exceeds my selected fundraising commitment.

I understand in the event I fall short of my fundraising commitment, I will not be eligible to attend the Opening Ceremony and will not be eligible to participate in the Ride. *

I understand in the event I fall short of my fundraising commitment, I will not be eligible to attend the Opening Ceremony and will not be eligible to participate in the Ride.

I understand that the fundraising commitment as shown on my Rider profile page will read as double my actual commitment (consistent with non-student riders). Student Riders are responsible for the commitment described in this registration process. *

I understand that the fundraising commitment as shown on my Rider profile page will read as double my actual commitment (consistent with non-student riders). Student Riders are responsible for the commitment described in this registration process.

100% of funds raised support

Academic Health System Partner

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Name

First

Last

Email Address *

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