JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
LHCOS Member Birthdays
Provide your name and address and be entered in a monthly birthday giveaway!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
You must be a member of the LHCOS Facebook group OR follow LHCOS on Instagram to win. Do you agree?
*
Yes
No
You must be active within the last 3 months to be eligible for a prize. That means you have either posted or commented on a post at least one time in the previous 3 months. Do you agree?
*
Yes
No
What is your name on Facebook? If you don't have FB, what is your Username on Instagram? (Must be following lhcos)
*
Your answer
If you are under 18 y/o you will be required to provide parental permission to receive your prize. Do you understand?
*
Yes
No
You will be required to provide your mailing address to the sponsor. Do you agree?
*
Yes
No
What is your birth date?
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
