Jr Rough Rider Membership Registration
If you would like to make a Rough Rider Membership gift along with Jr Rough Rider Memberships, please use the
combined form
.
https://medora.tfaforms.net/f/RRMember
Donor Information
First Name
Last Name
Birthdate
Mobile Phone #
Email Address
Street Address
City
State
Zip Code
Country
Donor's Relationship to Child(ren)
Please select...
Parent/Guardian
GrandParent
Other Relative
Friend
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Mobile Phone
Email
Street Address
City
State
Zip Code
Country
Jr Rough Rider Information
Enter information for an individual child. Click "Add another" at the bottom of this section for each additional child.
Child Information
First Name
Last Name
Birthdate
Email Address
Child's name as you would like it to appear in the Medora Musical Program
Count
Base Amount
$
Make my gift go further by adding 3% to cover processing fees
Additional Amount
Total Amount
Payment Information
Card Type
Please select...
Visa
MasterCard
Discover
American Express
Card Number
MM
YY
Code
Renew My Membership Automatically Each Year
Yes, I agree to have my Credit Card charged annually
No, do not automate my renewal
Contact Information