State Fair Competition Entry Form 2024

Iowa State Fair 2024 Entry Form

Enter to win pair of Concept by Iowa Hearing Devices
Date

MonthDayYearHourMinutesAM/PM Option
Are you registering for someone else*

YesNo
If filling this form out for someone else, enter THEIR address, phone, email, and birthdate.

If you do NOT know their
- birthdate - enter today's date
- address - enter UNK
- phone - enter 1111 for all spaces
- email - enter UNK
We must have a phone # or email for the entry to be valid.
Your Name*

First NameLast Name
Their Name*

First NameLast Name
Your relationship to them
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*

Area CodePhone Number
The Phone Number is*

Cell PhoneHome PhoneWork PhoneOther
2nd Phone Number

Area CodePhone Number
What type is your Cell Phone*

iPhoneAndroidOtherI do not have a cell phone
E-mail*
If you do not have an email, enter UNK
Date of Birth*

MonthDayYear
Do you currently wear hearing aids?

YesNo
Year of last hearing exam?
Have others noticed you like the TV loud?

YesNo
Do you hear people speaking but do not understand the conversation?

YesNo
Have you noticed people raise their voices to you?

YesNo
I heard about Concept's State Fair Giveaway (check all that apply)

RadioTVNewspaperFacebook/Social MediaConcept WebsiteAt the FairIn a ClinicOther
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