Dark Harbor Independent Grocers: October 2 - 15, 2019

OFFICIAL REGISTRATION FORM

Name/Nombre: Address/Dirección: City/Ciudad: State/Estado: Zip/Código postal: Contact number/Teléfono De Dia: Email/Correo electrónico : Confirm Email:
Date of Birth/Edad - I am at least eighteen (18) years of age as of October 2, 2019 and legal residents of California.
Tengo al menos dieciocho (18) años de edad al 2 de octubre de 2019.
Instructions for Attaching Your Receipt (Anexo con recibo):
1. Click the "Choose File" button below.
2. Find the image file of your receipt on your phone or computer.
3. Select Choose or OK.
4. Wait for the system to upload your receipt image.
5. Check the "I'm not a robot" box.
6. Click Submit.