*Where did you win the prize? (Location Name)
*What is the serial number on the certificate?
*When did you win the prize? (Approximate Date)
CONGRATULATIONS!
*If local, would you like to pick up your prize at
 our office in Ronkonkoma?
*What is your first name?
PRIZE REDEMPTION FORM
*What is your last name?
*What is your street address? Apt #
*What is your city?
*What is your state?
*What is your zip code?
*What is your phone number?
*Would you like for us to contact you for
 discounts and special offers?
*What year were you born?
**What day where you born?
**What month where you born?
Not Mandatory.  If you want a birthday gift sent to you, 
then you must answer the question.
What is your mobile phone number?
* YOU MUST FILL OUT ALL REQUIRED INFORMATION IN ORDER TO RECEIVE YOUR PRIZE.
**YOU MUST FILL OUT ALL REQUIRED INFORMATION IN ORDER TO RECEIVE FREE PLAY OFFERS & BIRTHDAY GIFTS.
*What prize did you win?
By submitting this form I authorize LISC to show my name in the current winners list.  By allowing us to publish your name we will be sending you free credits on your birthday to play our machines in the future.
**What is your email address?
CLAIM A PRIZE FORM
PLAY OUR MACHINES AND GET YOUR NAME PUBLISHED ON OUR SITE !
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