Love and Light Online VIP Guest List Form

No Cover Charge
Entrance through the VIP line - No Waiting!

Terms and Conditions
* Must Be 21 years or older.
* Valid ID required

* Request/Confirmation may be revoked at anytime for any reason.
* Only valid for Date Indicated Below
* You will put on the Love and Light Email announcement list
Please fill out the request form below and press submit button. You will received confirmation via email with a confirmation number that you should print and bring to the club.
A * indicates a required field.
VIP Valid DATE Friday, 1/9/2009
* First Name
* Last Name
Home Phone (include area code)
Cel Phone (include area code)
Birthday
Month
 Day
 Year (Optional)
* E-mail Address
Favorite Drink

How did you find out about our online VIP Guest List System?  

Other Source - Please Specify:
By submitting this VIP guest list request, you acknowledge that above information is true and correct to the best of your knowledge. You also agree to the terms and conditions below:
Terms and Conditions
* Must Be 21 years or older.
* Valid ID required
 * Request/Confirmation may be revoked at anytime for any reason.
* Only valid for Date Indicated Below
* You will put on the Love and Light Email announcement list
* I agree.
 


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