Renzi Holiday Bingo Form

Renzi Holiday Bingo Survey

Please answer the following questions about your scratch off ticket.
Name *

First Name Last Name
Email Address *
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Did you play the Renzi Holiday Bingo? *

Yes No
What is your ticket number? *
Must be between 001 and 500. Please enter as three-digit number (Ex: 1=001, 25=025, 100=100, etc.)
Congratulations! You revealed a Single Row Bingo!

Please answer the following questions about how you would like to retrieve your prize. Pick-up of prizes must be arranged during Renzi Education & Art Center office hours (Monday-Thursday, 9 AM - 2 PM; Friday, 9 AM - 3 PM) at 435 Egan Street, Shreveport, LA 71101. If within Shreveport-Bossier city limits, prizes will be delivered on Fridays at the discretion of Renzi Center staff, and if out of city limits, deliveries will be shipped within a week of confirmation at the discretion of Renzi Center staff.
Congratulations! You revealed a Big X Bingo!

Please answer the following questions about how you would like to retrieve your prize. Pick-up of prizes must be arranged during Renzi Education & Art Center office hours (Monday-Thursday, 9 AM - 2 PM; Friday, 9 AM - 3 PM) at 435 Egan Street, Shreveport, LA 71101. If within Shreveport-Bossier city limits, prizes will be delivered on Fridays at the discretion of Renzi Center staff, and if out of city limits, deliveries will be shipped within a week of confirmation at the discretion of Renzi Center staff.
Congratulations! You revealed a Blackout Bingo!

Please answer the following questions about how you would like to retrieve your prize. Pick-up of prizes must be arranged during Renzi Education & Art Center office hours (Monday-Thursday, 9 AM - 2 PM; Friday, 9 AM - 3 PM) at 435 Egan Street, Shreveport, LA 71101. If within Shreveport-Bossier city limits, prizes will be delivered on Fridays at the discretion of Renzi Center staff, and if out of city limits, deliveries will be shipped within a week of confirmation at the discretion of Renzi Center staff.
How would you like to collect your prize? *
Please select a day you would like to schedule the pick-up of your prize! *
Where would you like your prize to be delivered? *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
You did not win Renzi Holiday Bingo. Sorry!

Thank you for playing Renzi Holiday Bingo! Your ticket purchase directly benefits the Renzi Education & Art Center's free after school program, which offers academic and art classes to K-12 youth across Shreveport and Bossier City. While you did not win a prize, your support still has value for the children of our program!
Would you like to complete a short survey about the "Renzi Holiday Bingo" fundraiser? *

Yes No

Renzi Holiday Bingo Survey

Please answer the follow questions about the Renzi Holiday Bingo campaign to help us with producing future campaigns and events.
How did you hear about the Renzi Holiday Bingo? *

Social Media Email Website Family/Friend/Co-Worker
Would you be interested in participating in a scratch-off based game like this again to benefit our free after-school program? *

Yes No
What did you like about the "Renzi Holiday Bingo" campaign? *
What did you dislike about the "Renzi Holiday Bingo" campaign? *
Please share any final thoughts or comments about the "Renzi Holiday Bingo" campaign below.
If you would like, please submit any pictures of you and/or your friends or loved ones enjoying the "Renzi Holiday Bingo" together.

Browse Files
By submitting a picture to this form, you give permission for the Renzi Education & Art Center to use the picture for promotional purposes. Cancel of
Please verify that you are human *
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Renzi Holiday Bingo Survey