Wine Survivor Registration
Final Draw: November 18, 2018 1:00PM-4:00PM
Event Address: Barra Fion, 1505 Guelph Line, Burlington
Contact us at (289) 337-1508 or
Support The Camisole Project and enter to win Wine!
Registration Fee is $20
All registered participants are given a number that is entered into the draw.
You may pre-purchase one (1) Immunity Pass for $10 upon Registration, up to you!

Like Survivor, when your # is drawn, you have been voted OFF of Wine Island and are out of the draw.
If you have pre-purchased an Immunity Pass, this will be used to RE-ENTER you in the draw if your name is drawn.

The last 3 SURVIVOR numbers left to be pulled will WIN!
3rd last # drawn will win 15% of all entered bottles
2nd last # drawn will win 35% of all entered bottles
LAST # drawn will win 50% of all entered bottles

The final draw of the remaining 100 numbers will be held at Barra Fion on November 18.
Come join us for the exciting finale from 1:00PM-4:00PM

Name *
Your answer
Address *
Your answer
Phone # *
Your answer
Email *
Your answer
Wine *
Deadline for Registration/Payment/Wine delivery is October 18, 2018
*If the committee is NOT purchasing wine for you, please drop your wine off at BodyMed Boutique, 2033 Mount Forest Drive, Mount Royal Plaza, Burlington
To be Paid *
Payment *
I understand that I am not able to participate in Wine Survivor if my wine & money are not received before October 18, 2018 *
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