*Where did you win the prize? (Location Name)
*What is the serial number on the certificate?
*When did you win the prize? (Approximate Date)
*If local, would you like to pick up your prize at
our office in Ronkonkoma?
*What is your first name?
*What is your street address? Apt #
*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.
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?
PLAY OUR MACHINES AND GET YOUR NAME PUBLISHED ON OUR SITE !