You are viewing content from KJIL Western Kansas. Would you like to make this your preferred location?

Sign Up To Win - Mac Powell

Thanks for coming to the KJIL Booth at the Mac Powell show! Fill out the form below to be entered to win a t-shirt and prize package!

Full Name *

Spouse's Name

If Married, please include their name. (For Our Records Only)

T-Shirt Size (Adult Sizes) *

Address *

City / Town *

State *

Zip Code *

Email Address *

Mobile Phone *

Over 18? (For our records) *

Yes, I'm Over 18

No, I'm under 18

Guardian Name

(If Under 18, we need your Parent's or Guardian's Name)

Comments

Do you wish to receive updates from KJIL? *

Yes, I want to receive updates from KJIL

No, I don't want to receive updates from KJIL

This can be left alone:

Western Kansas