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Program Information
*First Name:
Middle Initial:
*Last Name:
Gender:
Male
Female
*Date of Birth (MM/DD/YYYY)
*Phone Number:
*Email:
*Address:
*City:
*State:
*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
Employee Name (Only used for Empire Mall New Player Enrollment):
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