Lottery TEST2023 Brooks Lodge Lottery Application TESTContact InformationFull Name (as it appears on identification)* First Middle Last Email Address (for notification of lottery results)* Phone NumberAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Trip DetailsNumber of Persons in Your Party**20 persons max per party. 4 persons max per room.Number of Rooms Requested ($850 per room per night)**5 room maximum. 3 person minimum per room if requesting 3 or more rooms.Preferred Number of Nights* 1 Night 2 Nights 3 Nights 4 Nights (June and August only) 5 Nights (June and August only)*3 nights is the maximum stay if one or more nights are during the month of July OR SeptemberIf your preferred number of nights is not available, what else will you accept? Check all that apply* None. I am only interested in my preferred number of nights above 1 Night 2 Nights 3 Nights 4 Nights 5 NightsI want to include: Flights from Anchorage to Brooks ($1350 roundtrip per person) Flights from King Salmon to Brooks ($450 roundtrip per person) Valley of 10,000 Smokes Tour ($106 per person w/ lunch)Preferred Dates OR Date Ranges. Please list in order of MOST preferred (click the ⊕ sign to list more than one date)*Start Date (MM/DD/YY)End Date (MM/DD/YY)Are you able to start your trip on any day during this time frame (YES or NO)? Brooks Lodge is open from June 1st – September 18th, 2024. Feel free to list up to 6 dates and/or date ranges (click the ⊕ sign to add more than one). Keep in mind, the more flexibility, the higher likelihood of being selected.CommentsIf there is any information you would like us to know about the dates listed above, please enter it here.Passenger InformationPassengers (click the ⊕ sign to add additional passengers)Full Name (as listed on ID)Birth Date (MM/DD/YYYY)Gender (Male or Female)Weight (lbs.) This information is required for booking flights. Please provide as much information as possible for each member of your party. Additional passengers can be added by clicking the ⊕ sign.Δ
