Contest Entry Form:
Please fill out the form below and someone from our team will be in touch soon to confirm your entry into the contest!
Email address *
Name *
Your answer
Are you at least 19 years of age? *
Please provide your Facebook Profile Link
So we can tag and notify you on Facebook!
Your answer
Phone Number *
Your answer
Have you read and understood the detailed contest rules at: https://www.greatermonctongirlsrock.com/2019-wine-survivor-raffle-rules/ *
Would you prefer to enter the contest by paying cash or via email money transfer? *
Would you prefer to provide a $15 bottle of wine or would you like to pay an extra $15 and we will purchase the wine for you? *
Advanced Immunity
When you enter this contest, you can pay a little bit extra in advance for immunity during elimination week. If you choose to do this, this means your name cannot be drawn during elimination week until the final day (Dec 20th). This option guarantees you will be in the race for as long as possible.
Would you like to buy Advanced Immunity during the week of elimination for $20? *
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