Cruisin' to the Square Registration Form
August 14, 2025, 4:30-7:00 at Jefferson, Iowa. Registration is free! Please register by completing the form below. Deadline for registration to get a free t-shirt is JULY 25. For more information, call 515-386-2155 or email info@jeffersonmatters.org.
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Vehicle Year, Make & Model
Club Affiliation (if applicaple)
What size of shirt would you like for your free t-shirt?
Small
Medium
Large
Extra Large
2X Large
3X Large
4X Large
If you would like to purchase extra t-shirts for $15 each, please list the quantity and sizes here.
Would you or your spouse be interested in participating in the Poker Walk event. This is a shopping event that involves stopping in the local shops and drawing a poker hand for a chance to win prizes.
Yes
No
Register
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