WBAT

BlockBuster Rentals

Here is how you can enter print form and fax:

 

 

 

REGISTRATION FORM

 

AFSCME Members and Court employees are invited to enter for a chance to win a movie rental. Local 3302 sponsors this promotion in cooperation with WBAT Ins. Winners will be chosen at random and need not be present to win. The contest deadline is April 1 -Sept 1, 2005. From now until the deadline, only winners that give permission to having their names published will be posted. Therefore, while drawings are held monthly, winners may not be posted every month. It is only necessary to enter once. All names entered will remain until drawn. Gift card for movie rental will be mailed to work address unless alternative address is provided. Please print legibly and fax completed form to (562) 425-5141 . Thank you for your participation.

 

Name:

 

Employee Number:

 

Employer:

 

Phone________________ Fax_______________ E-mail_________________

 

Department________________Address________________City____________________

 

 

 

Please indicate whether AFSCME Member or Court Employee?

 

 

 

Who should we contact in your work area to arrange a benefit review?

 

 

_______________________ ____________________ ___________________

N ame Title Telephone

 

 

 

 

 

 

 

By my signature, I grant permission to having my name published if I am a chosen winner.

 

 

_______________________________________

Signature

 

 

 

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Last Updated: October 18, 2007