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Tractor Ride Registration Form

5th Annual Scholarship Tractor Ride
Thursday, September 25, 2014

 

 
Please note: T-shirts are guaranteed for those who register before September 9.

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
XL
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:
Questions or comments? Please email us at info@iowalakes.edu or call 712-362-2604 or 800-521-5054.
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