This document is a registration form for DISH Network's contest to win a prize. It requests contact information such as name, address, phone numbers and email. It also asks questions about the entrant's current TV service and equipment to understand if they would be a good potential new customer for DISH Network. By signing, the entrant agrees to be contacted by DISH Network representatives.

1. Register to Win!
Name ______________________________________________________________________ Office Use Only
Address ____________________________________________________________________
City___________________________ State __________ ZIP Code ____________________
E-Mail Address _______________________________________________________________ Must be at least 18 to enter.
Home Phone _____________________________ Cell Phone _________________________
Are you or have you previously been a DISH Network customer? YES NO If yes, when? _______________
How do you get your current TV programming? Cable DirecTV Antenna Other
Do you have an HD (High Definition) TV? YES NO Do your own or rent your home? OWN RENT
If you have an HD TV, do you subscribe to an HD programming package or tier? YES NO
How many TVs are in your home? _______
How much do you spend monthly on TV service? $30-45 $45-60 $60-80 $80 or more
Signature
By completing and submitting this form, you agree to be contacted by an authorized DISH Network representative by phone and/or email.
Register to Win!
Name ______________________________________________________________________ Office Use Only
Address ____________________________________________________________________
City___________________________ State __________ ZIP Code ____________________
E-Mail Address _______________________________________________________________ Must be at least 18 to enter.
Home Phone _____________________________ Cell Phone _________________________
Are you or have you previously been a DISH Network customer? YES NO If yes, when? _______________
How do you get your current TV programming? Cable DirecTV Antenna Other
Do you have an HD (High Definition) TV? YES NO Do your own or rent your home? OWN RENT
If you have an HD TV, do you subscribe to an HD programming package or tier? YES NO
How many TVs are in your home? _______
How much do you spend monthly on TV service? $30-45 $45-60 $60-80 $80 or more
Signature
By completing and submitting this form, you agree to be contacted by an authorized DISH Network representative by phone and/or email.