Coatesville Bicycle Give-A-Way
To enter, please complete the form below. You must complete each line to be entered into the raffle and you must click "SUBMIT" for your enter to be recorded.
Person to Receive the Bicycle (first & last name):
Recipients Age (N/A if 18 or older):
(asked for the sole purpose of ensuring the proper bicycle request is made and if parent info is required)
Parent Name if a Minor (N/A if 18 or older):
Contact Phone # (Parent # if a Minor):
Email Address (Parent email if a Minor):
Recipients Physical Address:
Select your primary bicycle choice:
(Note: All three choices must be from the same category for the recipient entering the raffle based on their age
group. The ages listed with on the photos page is just a general guide. It is up to the parents if the recipient
is a minor as to what category they believe they fall into).
Select your secondary bicycle choice:
Select your third bicycle choice:
By entering this raffle, I have read and agree to all rules listed. If the recipient is a minor, I as the parent as listed under the Parent Name above have read and agree to all rules as listed. Please click the check box below to acknowledge your agreement.
Click the Submit button below to submit and confirm your entry.
Town of Coatesville, Indiana. All rights reserved.
Questions about Coatesville:
Contact Town Hall at 4994 Milton Street
Coatesville, IN 46121 765-386-7205
A n I n d i a n a M a i n S t r e e t C o m m u n i t y