Pull For Ag 2026

Randolph & Perry CFB Pull For Ag

Registration Form 2026
COMPLETE THIS FORM FOR EACH PARTICIPANT*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Mobile Number*
If you are part of a team: 1. Sporting Clays (4 person team) 2. All Junior Clays (3 person team)
Farm Bureau MemberWomenJunior (18 & under)Old Timer (65yrs+)None
T-Shirt Size*
If registering Non-Junior by July 1st, $70 per personIf registering Non-Junior after July 1st, $80 per person (no shirt guaranteed)Junior (18 & under), $45 per juniorGun raffle ticket, $10 eachUnable to participate, but would like to give a tax-deductible contribution
Total Amount Owed (if you are buying a raffle ticket, please put how many)*
CheckCredit CardCash
CC PAYMENT: (Visa, MasterCard, or Discover)
CC PAYMENT: Card Holder Name
CC PAYMENT: Card Number
CC PAYMENT: CSV
3 numbers on the back of your card
CC PAYMENT: Expiration Date (month/year)
CC PAYMENT: Billing Address, State, & Zip
CC PAYMENT: Total Amount
Email address for sending transaction receipt
If paying by check make payable to RCFB Foundation and mail to: PO Box 504, Sparta, IL 62286-0504
Have questions? Please call 618-443-4511 or email manager@rcfb.org
Other Comments:
Should be Empty:

Randolph & Perry CFB Pull For Ag