Rider Information

First Name
Last Name
Street Address
Zip Code
Phone Number
Email Address
Confirm Email Address
If you are riding in honor or memory of someone, please list their name(s) here:
In Memory Of...
In Honor Of...

Referred by a Friend?

Were you referred by a friend who is already registered? Let us know who referred you and you will be eligible for our Bring a Friend promotion.

Please start typing the name in the box below, and select the correct name from the list that appears.

Name of Rider

Login Information

This will allow you to login to your personal fundraising profile.

Confirm Password

Employer Information

Providing your employer can help us connect you with potential matching funds and earn team incentives.

My current employer is:

Emergency Contact

Who should we contact in case of an emergency? Please enter a cell phone number if your emergency contact is another PTC participant so we can be sure to reach them.

Emergency Contact Name
Phone Number

Living Proof

PTC19 Living Proof

Are you a cancer survivor and/or currently fighting cancer? Let us know and you will receive a complimentary Living Proof T-shirt that you can pick up in the Siteman Cancer Center tent at event weekend. Wear it for the Living Proof photo, which will take place on Saturday, Sept. 28 during the Inspirational Program.