Ford KTP Cares

Entry Form

Full Name (Print)__________________________
Street Address ___________________________
City, State ______________________________	Zip ____________
Daytime or Cell Phone _____________________	Age____________
Email Address ____________________________
Name of extra rider ________________________	Age ___________

	Cost
Non refundable registration rider fee (includes snacks & poker hand) - $15	_______________
Non refundable registration passenger fee (includes snacks & poker hand) - $15	_______________
All you can eat buffet lunch especially for our ride group - $15 each lunch	_______________
Customized ride t-shirt - available for purchase prior to day of ride - limited number available on day of ride for $15 (indicate size - M L XL XXL XXXL) - $12	_______________
Passenger ride t-shirt (indicate size - M L XL XXL XXXL) - $12	_______________
JDRF Donation	_______________
Total	_______________
Mail entry form with check/money order made payable to Ford KTP Cares to: P.O. Box 895, Pewee Valley, KY 40056 or submit at KTP Salaried Personnel office.