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 The Southern Flames  present  Stevi Belle

Lottery Form

 Name:                                                                                                              

Address:                                                                                                          

                                                                                                                       

Telephone:                                                                                                       

Alternate Telephone (mobile):                                                                           

Email Address:                                                                                                 

  Stevi Belle Class Preference (only check one):

               Only able to attend September 11 & 12, 2004 (Saturday / Sunday)

              Only able to attend September 13 & 14, 2004 (Monday / Tuesday)

               Can attend either session, prefer Sat/Sun – You may be placed in either class.

               Can attend either session, prefer Mon/Tues – You may be placed in either class.

 Do you want to be on the waiting list if your name is not drawn for a class session (circle one)?  yes    no

 If you will not be at the meeting for the lottery, please print out and complete this form, then mail it with a check to “Southern Flames” for $325 to:

Southern Flames

Box 11A

311 Peachtree Hills Avenue

Atlanta, GA  30305

 

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For Southern Flames Administrative Use Only

Received On _________   Check # __________

 

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