KLMJ Radio Freq Pedal & Putt
Saturday, June 24, 2017
Starting time 7:30 to 8:30 a.m.

Fee $10 per person. Complete this form, and click submit at the end. Then, please mail or deliver your registration fee to KLMJ Radio, P.O. Box 495, Hampton, IA 50441. Make checks payable to American Cancer Society. You may also call (641) 456-5656 to authorize a credit card payment.

Printed registrations are also available to fill out at the KLMJ Studios on Highway 65 North in Hampton.

The ride will begin at the Franklin Wellness Center in Hampton and the route follows the Rolling Prairie Trail to Coulter with miniature golf set up along the way. Prizes will be awarded including a brand new Trek Verse 1 bicycle from Spoken Wheel Cyclery in Iowa Falls (pictured below).

All proceeds benefit the 2017 Franklin County Relay for Life.

Contact info
Please provide complete contact information in the spaces below.
Your name
First and last name
Your answer
Your address:
Street; City, State; Zip
Your answer
Phone number
Include area code
Your answer
E-mail
Your answer
How many people are you registering?
Please enter the number of people you are signing up for the "Pedal & Putt". Registration fee is $10 x number of registrants.
Your answer
How will you be sending payment?
Required
Questions and comments
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of CD Broadcasting. Report Abuse - Terms of Service - Additional Terms