herman winks gundlach read to ride entry form
TRANSCRIPT
First Name:
Number/Street/Apt. or P.O. Box/Route:
MI: Last Name:
Date of Birth
/ /
State: Zip Code:City:
Herman "Winks" Gundlach Read to Ride Entry Form
*Must be a resident of Baraga, Gogebic, Houghton, Keweenaw or Ontonagon County and between the ages of 6 and 14 (by July 30, 2012) to win.
County - Check one: Baraga Gogebic Houghton Keweenaw Ontonagon
Phone:
- -School:
Verify by parent / guardian signature:
1.Name of Book:
Author Last Name and First Initial: Date Completed:
/ /
Child needs to read only one book to enter, but each book will entitle the child to one chance to win. NO COMIC BOOKS! Books should be at student's readinglevel. HONOR SYSTEM! Parents may fill out the form - illegible forms will be discarded.
Entry forms must be returned by July 30, 2012 to the child's school office, the local public library, or the REMC #1 office at the Copper Country IntermediateSchool District, 809 Hecla Street, Hancock. Forms may be mailed to REMC #1, 809 Hecla St, Hancock, MI 49930 and must be postmarked by July 30, 2012.Additional forms are available on the web at www.readtoride.net. The online form is a fillable PDF document - complete, print, sign and return to REMC #1.
Winners will be drawn on Tuesday, August 7, 2012.
Sponsored by:REMC #1 / Copper Country & Gogebic-Ontonagon Intermediate School Districts,
Daily Mining Gazette, Good Will Farm, and Houghton Rotary
2.
Name of Book:
Author Last Name and First Initial: Date Completed:
/ /
3.Name of Book:
Author Last Name and First Initial: Date Completed:
/ /
4.Name of Book:
Author Last Name and First Initial: Date Completed:
/ /
5.Name of Book:
Author Last Name and First Initial: Date Completed:
/ /
*** Please use a black pen to fill out this form ***