PROXY FORMThe Proxy Form will take approximately 8 minutes to complete. This form must be completed by the winner in order to proxy their Lady Luck Women in Country Music trip prize and be submitted no later than May 30, 2025. Todays Date * MM DD YYYY Your State Lottery * Prize Winner's First and Last Name * First Name Last Name Proxy's First and Last Name * First Name Last Name Proxy Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Proxy Email * Proxy Phone * (###) ### #### Terms and Conditions * - By completing this form, I, the original prize winner acknowledge that I will not attend the Lady Luck event on August 24 – 27, 2025. - As the original prize winner, I agree that my Proxy will attend the event in Pigeon Forge in my place. - The original prize winner shall remain subject to tax reporting and tax withholding by the state lottery that the Lady Luck prize package was won. - Any travel arrangements booked prior to naming a proxy for the original prize winner and their guest, the winner will be responsible for all additional expenses incurred for booking travel for the proxy. - Proxies are not eligible for any cash prizes awarded during the event. The original prize winner is only eligible and will be automatically entered into the drawings announced during the event and will be notified of any winnings post event. - Once proxied, the winner will not receive any event emails and they will be sent directly to the proxy. - I acknowledge and agree with all terms and conditions. I agree to the terms and conditions Thank you!
