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The Southern Flames present  LISA ST MARTIN Lottery Form

 Name:                                                                                                              

Address:                                                                                                          

                                                                                                                       

Telephone:                                                                                                       

Alternate Telephone (mobile):                                                                           

Email Address:                                                                                                 

 

Lisa St Martin Class Preference (only check one):

 

              Only able to attend April 24 & 25, 2008 (Thursday/Friday) 

 

  Filled            Only able to attend April 26 & 27, 2008 (Saturday/Sunday)

 

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

 

    Filled         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 February 23,2008 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 Feb 22, 2008

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For Southern Flames Administrative Use Only

Received On _________   Check # __________

 

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