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 The Southern Flames present  BRAD PEARSON SHAPING Lottery Form

 Name:                                                                                                              

Address:                                                                                                          

                                                                                                                       

Telephone:                                                                                                       

Alternate Telephone (mobile):                                                                           

Email Address:                                                                                                 

 Brad Pearson SHAPING Class Preference (only check one):

Please rank by preference (one, two) your class preferences below.

               Only able to attend Thursday, May 12, (shaping class)

              Only able to attend Saturday, May 14, (shaping class)

 _______  Can attend either Thursday, May 12 or Saturday, May 14 but prefer (circle preference )       _____ Thursday, May 12        _____ Saturday, May 14

 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 Wednesday, March 9, 2005 Southern Flames meeting, or you can mail the completed form and your check in the amount of $ 125.00 made payable to “Southern Flames” by March 7th to:

Southern Flames

311 Peachtree Hills Avenue, Box 11A

Atlanta, GA  30305

NOTE:  MAILED CHECKS AND FORMS MUST BE RECEIVED BY Mon March 7, 2005

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For Southern Flames Administrative Use Only

Received On _________   Check # __________

 

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