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Prize claim form

Mar 15, 2006 07:18 AM
by krsanna


Grand prize winner of deluxe voodoo doll with extra pins to guard 
against stray IP numbers that can be traced.  Deluxe voodoo doll is 
shipped with extra cheerleading costume, special forces galactica 
badge and four-color ID card.    

THE WINNER:  JERRY HEYKA-EKINS

SPECIAL PRIZE CLAIM FORM

Name:  
Social Security #
Street Address with zip code (post office boxes not accepted):  
Date of birth and hometown:  
Year first attended kindergarten:
Ranking in graduating class of highest degree attained:
In 200 words or less, please explain you how you will use the deluxe 
voodoo doll and your plans for the future.  

ATTEST:

I hold Krsanna harmless of any and all voodoo artifacts, intentional 
or accidental, that I understand the importance of the equilibrium 
of the Kosmos, and will use my deluxe voodoo doll with pins and 
extra cheerleading costume with the respect and diligence they 
deserve.

I hold harmless Krsanna and all theosophists if I get caught spying 
for any government or military force.  

SIGNED:  ___________________________  DATE: ______________________











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