Submit a Ride Dedication

We will be dedicating each day of the ride to someone who has died from lung cancer as well as someone who is surviving and would greatly appreciate your participation. Please use the form below to submit a photo with name and a few details about the person that you would like to remember or, if you are a lung cancer survivor, please submit your own story with a photo . Part of raising awareness is putting a face to this disease. Please help me share your stories!

Your Name*
First Last
Your Email*
Your Phone #
Dedication Information
Dedication Type*
- In memory of
- In honor of
Name*

(as it would appear online)
State, region, or city/town

(as it would appear online)
Information about the person.*
(as it would appear online)
Photo/s (3 files, 20MB max)
Drop files here or

Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 20 MB, Max. files: 3.
Consent*
I Agree: By submitting this form you agree to allow the BikeBreatheBelieve lung cancer awareness campaign and all those associated with said campaign to publish the photo and information you have provided in this form on the BikeBreatheBelieve.org website and all associated social media.
Comments
This field is for validation purposes and should be left unchanged.

Dedication Information