MASS LOTTERY $10,000,000 HOLD ‘EM POKER®
MERCHANDISE PRIZE PACK REDEMPTION FORM

WINNERS NOTE: If you cannot print this form, please indicate legibly on a card or piece of paper your prize selections, as offered below. Include the information in an envelope along with your PRIZE PACK-winning ticket with information on the ticket back completed legibly. Affix proper postage and mail your redemption information to the address shown below.

In the boxes provided below, type in the information requested, then print out the completed form, put it in an envelope with proper postage affixed and mail it with your MERCHANDISE PRIZE PACK-winning Hold ‘Em Poker ticket to the following address:

MASS LOTTERY HOLD ‘EM POKER PROMOTION
P.O. BOX 9276
WALTHAM, MA 02454-9276
NAME
SHIPPING ADDRESS
SHIPPING ADDRESS LINE 2
CITY
STATE
ZIP CODE
CONTACT TELEPHONE

Click on the box adjacent to the PRIZE PACK of your choice (PRIZE PACK A, PRIZE PACK B or PRIZE PACK C). Also, select your choice of options, if you choose PRIZE PACK A or PRIZE PACK C.

Hold ‘Em Poker table (choice of two styles) and official World Poker Tour™ 500-count chip set
 
71” x 35” x 30” professional poker table
    OR
 
octagonal folding leg poker table
Table top, chip set, shuffler, clock, tumblers, cooler bag, watch set, blanket, poker DVDs.
Leather jacket, leather bag, cap, sunglasses.
  JACKET STYLE
 
MEN'S
 
WOMEN'S
  JACKET SIZE
 
small
 
medium
 
large
 
extra large
 
double extra large