WIN A $1000 SHOPPING SPREE!

Fill out the form below and register to win a
$1000 shopping spree with any one of our advertisers.
Let us know which of our advertisers you have patronized.
We will be holding a drawing on May 15, 2009.

The winner will be notified by certified mail.
Please be sure that your address is correct.

FIELDS MARKED WITH * ARE REQUIRED

Click here for a printable version of this form that can be mailed to us.

 Your Name:*          

 Address:*                
 
 City, ST, Zip:*        

Phone Number:*     

 E-Mail Address:*      

                                   Businesses you have patronized or comments*:                                                                                                   
                                    


Please contact me about advertising in Seniors Choice Directories.

Please click the Submit button to e-mail this form to us using your default e-mail application.

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