COMPLETE THIS FORM AND TELL US WHY YOU AND THAT SPECIAL PERSON IN YOUR LIFE DESERVE A SPECIAL NIGHT ON THE TOWN.
WINNERS WILL BE TREATED TO A DELICIOUS DINNER AND A FABULOUS CONCERT.
Your registration information is for the use of KLRR only. We collect information in order to keep you informed of contests and events sponsored or promoted by KLRR. KLRR will not sell, rent or in any way distribute personal information supplied to us by you. The information you provide us stays with KLRR only.