Members Bottle Drawing Entry

Members Bottle Draw Entry MUST BE AN EVERGREEN MEMBER Please fill out ALL information and then Print out this page and send with your Payment

First Name:

Last Name

Address City

State Zip Code:

AMOUNT SENT

Please Check which Drawings you wish the amount enclosed be applied to:

Ticket Price: 6 Tickets for $5

MAIL TO : EVERGREEN STATE BEAM CLUB ATTN: BOTTLE DRAW ENTRY 519 NE 165TH #E-12 SEATTLE, WA 98155 If unable to Print, Please make sure you include the above information with your payment

ANY QUESTIONS PLEASE FEEL FREE TO EMAIL US

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