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The
Southern Flames present
Stevi
Belle
Lottery
Form
Name:
Address:
Telephone:
Alternate
Telephone (mobile):
Email Address:
Stevi
Belle Class Preference (only check one):
Only able to attend September 11 & 12, 2004 (Saturday / Sunday)
Only able to attend September 13 & 14, 2004 (Monday / Tuesday)
Can attend either session, prefer Sat/Sun – You may be placed in either class.
Can attend either session, prefer Mon/Tues – 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
If you will not be at the meeting for the lottery, please print out and complete this form, then mail it with a check to “Southern Flames” for $325 to:
Southern Flames
Box 11A
311 Peachtree Hills Avenue
Atlanta, GA 30305
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For Southern Flames Administrative Use Only
Received On _________ Check # __________
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