Tractor Ride Registration Form

4th Annual Scholarship Tractor Ride
Thursday, August 31, 2013

Indicates a Required Field

First Name:

Last Name:

Street Address:

City:

State:

Zip:

Phone Number:

Email Address:

Rider name if different than above:

Tshirt Size:

Small

Medium

Large

2XL

3XL

4XL

Tractor Year:

Tractor Make:

Tractor Model:

Tractor Traveling Speed:

$25 Per Rider:

Includes T-shirt, lunch and donation to scholarship fund

Payment Method:

I will mail a check payable to Iowa Lakes Community College Foundation

Please bill me for the total amount due

Payroll Deduct for Employees of Iowa Lakes

Verification Code:

If you are not sure what the words are, enter your best guess.