KJazz 88.1

Sweepstakes Entry Form

Updated: 12/7/2021 06:31

To be entered into the sweepstakes please fill out the following fields:

Step One: Personal Information

Title
Mr Mrs Ms Miss Dr Rev Ret

First name

Middle initial

Last name

Suffix
Jr Sr III IV

Date of birth
MONTH January February March April May June July August September October November December DAY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YEAR 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Step Two: Contact Information

Company

Address

City

State/Province
Choose a State / Province Not USA or Canada US States AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY US Terrirtories AS FM GU MH MP PR PW VI US Military AA AE AP Canadian Provinces AB BC MB NB NF NS NT NU ON PE QC SK YT

Zip/postal code

Country
Choose a Country United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Educational Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland Former Czechoslovakia Former USSR France French Guyana French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe (French) Guam (USA) Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast (Cote D'Ivoire) Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyz Republic (Kyrgyzstan) Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique (French) Mauritania Mauritius Mayotte Mexico Micronesia Moldavia Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia (French) New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Polynesia (French) Portugal Puerto Rico Qatar Reunion (French) Romania Russian Federation Rwanda Saint Helena Saint Kitts & Nevis Anguilla Saint Lucia Saint Pierre and Miquelon Saint Tome and Principe Saint Vincent & Grenadines Samoa San Marino Saudi Arabia Senegal Seychelles S. Georgia & S. Sandwich Isls. Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Tadjikistan Taiwan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay USA Minor Outlying Islands Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (USA) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe

Email

Phone 1

Phone 2

Step Three: Review and Submit

Please review your information then click the Submit button.
DO NOT CLICK THE SUBMIT BUTTON MORE THAN ONCE

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