ENTRY FORM

ONLINE ENTRY FORM
Limited to ONE entry per person!

* Indicates required field

Name *

First

Last

Select ONLY ONE Age Group *

0 - 5 years 6 - 10 years 11 - 15 years 16 years and older

Enter Mailing Address on first line. Enter email address on 2nd line. Enter City in the first SMALL line. Enter the ZIP Code in the second SMALL line. Enter the Ka'u Community you LIVE in in the third SMALL line. If you are a parent of the recipient who is 17 years of age or younger, Enter YOUR FIRST & LAST NAME in the fourth SMALL line. *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

PRAYER REQUEST - Please specify person, prayer need and any other information you would like to provide. Thank you! *

BY SUBMITTING YOUR ENTRY, YOU CERTIFY THAT YOU HAVE READ, UNDERSTAND, QUALIFY AND AGREE WITH THE COMPLETE RULES.

ENTRY FORM FOR THEUNDERCOVER ANGEL TREE GIFT DRAWINGAn Outreach Project ofHope DIA-mend Ministries

ONLINE ENTRY FORMLimited to ONE entry per person!

ENTRY FORM FOR THE
UNDERCOVER ANGEL TREE GIFT DRAWING
An Outreach Project of
Hope DIA-mend Ministries

ONLINE ENTRY FORM
Limited to ONE entry per person!