Registration Information

First Name *

Last Name *

Farm or Ranch Name

Address *

Address Line 2

City *

State *

Zip Code *

Telephone *

Email Address *

What are the Names of Those Attending? Please include last name if different from yours. *

Please select how many of each option you would like (one per person, of course)

Roasted Pork Loin with Garlic Potatoes
Cranberry and Sage stuffed chicken with Rice Pilaf
Gnocchi Ratatouille with Sweet Potato Hash

Would you like to donate an item to the silent auction? Let us know and we will contact you with details.

Payment

How many dinners are you reserving? *

One $45

Two $90

Three $135

Four $180

Five $225

If you prefer to pay by check hit the continue button below and you will get an email reply with all the information you put in.

You may print out the email (or print the form now) and send it along with the check to:

IYAK
c/o Claire Roberts
3327 290th Ave
Hill City, KS 67642