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The Southern Flames present  BRENT GRABER Lottery Form

 Name:                                                                                                              

Address:                                                                                                          

                                                                                                                       

Telephone:                                                                                                       

Alternate Telephone (mobile):                                                                           

Email Address:                                                                                                 

 

Brent Graber Class Preference (only check one):

 

              Only able to attend February 21 & 22, 2008 (Thursday/Friday) 

 

              Only able to attend February 23 & 24, 2008 (Saturday/Sunday)

 

              Can attend either session, prefer Thursday/Friday -You may be placed in either class.

 

              Can attend either session, prefer Saturday/Sunday – 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

 

Please print out and complete this form.  You can either drop this form and your check off at the Wed December 12,2007 Southern Flames meeting, or you can mail the completed form and your check in the amount of $260.00 made payable to “Southern Flames” to:

Southern Flames

c/o Kim Runge

311 Peachtree Hills Avenue, Box 11A

Atlanta, GA  30305

NOTE:  Mailed CHECKS AND FORMS MUST BE RECEIVED BY KIM RUNGE by Tues Dec 11, 2007

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For Southern Flames Administrative Use Only

Received On _________   Check # __________

 

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