contest entry form

NOTE: When you send in your entry form, please let us know how you heard about the contest. Thank you!

Click here for a printable entry form (PDF)

ENTRY FORM: mail to, P.O. Box 245 Yachats, OR 97498

win-this-home.com, Inc. ( ENTRY #______OFFICE USE ONLY)

ENTRANT NAME (Print)_____________________________ 

ADDRESS_________________________   ____________________

EMAIL____________________________DATE_____

I have read and understand the rules of this contest.

Signed___________________________________

ENTRY FEE, CHECK__MONEY ORDER__

SASE ENCLOSED__(OFFICE USE ONLY)

All entrants must be over 21 years of age*ALL ENTRIES MUST BE LEGIBLE*

_______________________________________________________
(ENTRY MUST BE 100 WORDS OR LESS.

ENTRY#______(OFFICE USE ONLY)

THE THEME IS “ I/WE WANT TO WIN THIS HOME IN YACHATS BECAUSE”, which should be within the essay.