Charity Auto Event To Raise Funds
 for Youth Programming in the
Minneapolis/Saint Paul Metro Area

To participate in Drive for Kids 2003, complete the online form below.  After clicking the "submit" button, you'll will have the option to make payment online using your credit card through PayPal.   You may also print out the form below and mail with your payment to Drive for Kids;  c/o The Portage for Youth; 965 Fremont Avenue;  Saint Paul, Minnesota 55106

 

Individual Driver--$45
(1 vehicle, includes all passengers/1 free t-shirt)
No. of passengers

Club/Business--$250 per organization
No. of vehicles (up to 6, 1 free t-shirt per vehicle)

Sponsor a driver for 140 mile drive:
$.25 per mile ($35.00)
$.50 per mile ($70.00)
$1.00 per mile ($140.00)
Other $
Participant being sponsored:

I am unable to participate. Enclosed is my donation of $.
Please send me registration brochures.
First Name:      First Name:
Business/
Organization:
Address:
City:
State:

ZIP: 

Phone:

Fax: 

Email:
Email (confirm):

If you are printing and mailing this form and wish to pay by credit card, please provide the following information:

Credit Card Number:   __ __ __ __    __ __ __ __    __ __ __ __    __ __ __ __

Expiration Date: _____ / _____ / _____

Signature ________________________________________

Thank you!