NAME ________________________________________________________
ADDRESS_____________________________________________________
______________________________________________________________
CITY________________________________________________
STATE __________________ZIP_________________________
EMAIL________________________________________________
HOME PHONE___________________________________________
YEARS SWEEPING_____Biggest prize_____________________
I would like to pay using: (circle) CHECK ////// MONEY ORDER
Please list any affiliation with local sweepstakes clubs:
Please list any affiliation with online sweep clubs (online-sweepstakes.com, sweepsheet, etc):
Would you be willing to help volunteer? (one hour or so) YES ////// NO
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For assistance, contact Rob Nease at: HMCRob@gmail.com
Please print out this form, complete it by using neat handwriting, and mail to:
