We are delighted to offer you the chance to win a
Dinner for Two!

We are taking this opportunity to include your name on
our preferred guest list.

This will allow us to keep you updated on special events
in the restaurant.

It’s a way for us to show how much we appreciate our guests.

Thank You!  

		Mr. Mrs. Ms. Dr.
First Name:
Last Name:
Email Address:
Street Address:
City:
Province/State:		Alberta Alaska Alabama Arkansas Arizona British Columbia Bermuda California Colorado Connecticut District of Columbia Delaware Florida France Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Labrador Massachusetts Manitoba Maryland Maine Mexico Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska Newfoundland New Hampshire New Jersey New Mexico Nova Scotia Nevada North West Territories New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Québec Puerto Rico Rhode Island South Carolina South Dakota Saskatchewan Tennessee Marianas Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Yukon Nunavut England Scotland Nothern Ireland Wales	Zip/Postal Code:
Telephone:
Birthday:	Month:		Day:
Comments: