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*First Name:
Middle Initial:
*Last Name:
Gender:
*Date of Birth (MM/DD/YYYY)
*Phone Number:
*Email:
*Address:
*City:
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*Zip:
Anniversary Date (type NA if not married):

Where have you seen our advertising?
Television Radio Billboards
Website Print/Newspaper Magazine
Empire Mall Sioux Falls Sport Events  

What kind of music are you interested in?
Pop/Top 40 Blues Big Band
Rock & Roll Country/Western Jazz
Classical    

What type of Casino Games do you prefer?
Slots - Las Vegas Reels Slots - Digital Video Blackjack
Live Poker Off Track Betting  

What type of promotions interest you?
Vehicle Giveaways Cash Giveaways Vacation Getaways
Slot Tournaments Match Pays Poker Tournaments
Blackjack Tournaments    
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