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 The Southern Flames present  BRAD PEARSON LARGE MANDREL Lottery Form

 Name:                                                                                                              

Address:                                                                                                          

                                                                                                                       

Telephone:                                                                                                       

Alternate Telephone (mobile):                                                                           

Email Address:                                                                                                 

 Pearson LARGE MANDREL Preference (only check one):

              Only able to attend Friday, May 13, (Large mandrel class)

               Only able to attend Sunday, May 15, (large mandrel class)

 ______  Can attend either Friday, May 13 or Sunday, May 15 but prefer (circle preference )             _____ Friday, May 13             _____Sunday, May 15

 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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