Illinois Agriculture in the Classroom Bike Ride

September 7-10 2010

Ford, Grundy, Kankakee, Livingston, Iroquois and Will Counties

Please note:  This form is to be used for on-line credit card payments only.  If you plan to pay by check, please click here for the mail-in registration form.  The following are accepted:  MasterCard, Visa, Discover.  All riders registering on line are required to pay the registration fee.  If you are collecting over $250 in donations, you will be refunded your registration fee once all donations are processed by the IAA Foundation.  All riders are billed for their meals and accommodations after the ride.

*=Required
Prefix: 
First Name:*           Middle Initial: 
Last Name:*                    Suffix: 
Name as it appears on credit card if different than name of registrant:  
Address:*                 
City:*                 
State:*                    Zip:*                 
County*:                
Email:*                 
Daytime Phone*:                 
Evening Phone: 
I will attend the kickoff dinner: Yes       No
I will ride on the IAITC Bike Ride:  
       (check all that apply) Tuesday Sept. 7     Wednesday Sept.8    Thursday Sept. 9
I will require overnight accommodations:
       (check all that apply) Monday Sept. 6    Tuesday Sept. 7         Wednesday Sept. 8
I prefer a single room and agree to pay the single rate:  Yes      No

If I raise $1,000 I will pay the difference between the single room rate and ½ the double rate. 

I am willing to share a room:*  Yes      No
  My Roommate Preference is: 
I will be eating meals:    
       (check all that apply) Tuesday Sept. 7     Wednesday Sept. 8    Thursday Sept. 9
T-shirt size:  Small     Medium      Large     XLarge     XXlarge
Please include any details about your ride that could help us plan for meals.  For example, if you are riding on Tuesday only and not staying for dinner let us know so we can have accurate meal counts.

Once you submit this form you will be given the opportunity to review the information you have entered, then directed to our secure server to complete the transaction with your credit card.  Please submit a separate registration and payment for each rider.

Registration Fee per rider:
  Adult: $75  ($95 after August 21)
  Child: $25 per child under 12 yrs