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AWS, 113 South Perry St. Lawrenceville, GA 30045
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TOTAL ENTRY FEES DUE = Number of Entries X US$20.00
Name: ______________________________________________________
Telephone: ____________________ E-mail: _______________________
Street: ______________________________________________________
State or ZIP or
City: ____________________ Province: _____ Postal Code: __________
I (We) certify that I am (we are) the winemaker(s) of the above listed wines.
Signature: _______________________________ Date: ______________
Signature: _______________________________ Date: ______________