Thank you for supporting RhythmRIDE for Zimbabwe. Please print and fax or mail this form to BCAP!

Contact Information

Full Name: ______________________________

Address: ______________________________

City: ______________________________ State: _____

Zip Code: ______________________________

Email: ______________________________
Please include your email address so I can email you your tax deductible receipt, instead of wasting valuable paper and postage.

Phone: ______________________________

Billing Information (Credit Card or Check)

Credit Card Type: Visa _____ Mastercard _____ Discover _____

Credit Card Number: ______________________________

Expiration Date: ______________________________

Pledge Amount:

Make checks payable to BCAP, with "RhythmRIDE for Zimbabwe" in the memo line. Please fax this form to
303-444-0260 with your credit card information or mail the form with a check, money order or credit card information to:

BCAP
2118 14th Street
Boulder, CO 80302

Attn: RhythmRIDE for Zimbabwe

Would you like to receive e-mail updates to stay informed about RhythmRIDE for Zimbabwe's progress?
Yes _____ No _____
Would you like to receive emails from BCAP and their partners?
Yes _____ No _____

Thank you for your support!