NAME________________________________________________________
ADDRESS_____________________________________________________
CITY, STATE, PROVINCE, ZIP_____________________________________
COUNTRY____________________________________________________
PHONE NUMBER (DAY)_________________________________________
PHONE NUMBER (EVENING)_____________________________________
E-MAIL ADDRESS______________________________________________
(Please circle type of payment)
$ AMOUNT ENCLOSED___________ CHECK MONEY ORDER
HOW DID YOU LEARN OF THIS DRAWING?
_____________________________________________________________
WOULD YOU LIKE TO BE ADDED TO ANY OF THE FOLLOWING E-MAILING LISTS?
(E-Mailing list participation is optional and will in no way affect eligibility in prize drawing)
Please place an "X" next to desired e-mail list
____ The Cape Cod Store.com's Lighthouse Collector's Club
____ The Cape Cod Store.com monthly newsletter
____ Bronze Lady of Orlando Collector's updates
Mail this form along with check or money order made out to Sand and Sea Enterprises/ Lighthouse Fund
Sand and Sea Enterprises
Collector Forums Opportunity Drawing
PO Box 850
8 Jasmine Way
South Dennis, MA 02660