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2015 Bike MS: City to Shore Prize & Plaque Request Form

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5 to 60 characters


5 to 20 characters








Anniversary Year Plaque Request

Note: If you do not request a plaque, one will not be ordered for you.




Team Achievement Award Plaque Request


Teams raising $5,000 or more have the opportunity to receieve a plaque in recognition of their fundraising accomplishments. Note: If you do not request a plaque, one will not be ordered for you.



Prize Request


Question - Not Required - Would you like a prize?




VIP Club: $1000+


Fundraising Levels

$1,000-$2,499: Gold Level
$2,500-$4,999: Platinum Level
$5,000-$9,999: Diamond Level
$10,000-$14,999: Challenge Accepted *New in 2015*
$15,000-$19,999 Mission Possible Level
$20,000-$24,999: Tour of Champions 
$25,000+**: Millennium Circle




Question - Not Required - If you would like us to mail you a VIP Jersey, what size would you like?


Summit Group Prizes - How it works:

>A prize code, and the redemption website, will be mailed and emailed the first week of November to those who submitted their Prize Request Form by October 31.

>You will have 60 days to visit the redemption website and select the prize of your choice:
        >> You may pick from a lower prize level
>> Only one prize per person
        >> No exchanges

> After selecting your prize, you will receive a confirmation notification from the Summit Group. Prizes will be mailed approximately two weeks after the Summit Group confirmation email.

*Prize redemption only, no plaque

**Prize(s) valued at $600 or more are considered income by the IRS and, as such, you are required to pay tax on that income. The Chapter must, by law, obtain your social security number and report such income to the IRS if you choose a prize(s) valued at this amount.


Questions? Contact Lauren Dietz at 1-800-445-BIKE or by email.


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Learn more about Bike MS events nationwide

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Bicycling Magazine: 1 Year for $7

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*includes a special free water bottle. Proceeds benefit Bike MS.

View special offers just for Bike MS cyclists


Thank you to our national sponsors


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