Survey

"Win a Date with Mr. Dani" Entry Form

Please tell us in 50 words or less why you would
like to win a date with Mr. Dani (required):

Name (required):

Address (optional):

E-mail (required):

Phone (required):

Link to MySpace
or Facebook page
with your picture:

By clicking the "Submit" button and entering the contest, I certify that I am a female, 25 years of age or older.

All information is for our use only. It is strictly confidential and will not be made available to any other person or company.

After you click "Submit," if you didn't provide a picture link above, you will be
able to e-mail the judges a picture of yourself.

Thank you.

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Site design by Dominick J. Fontana.

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e-mail: nypizzaking@danishouseofpizza.com

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Win a Date Entry Form

81-28 Lefferts Blvd. - Kew Gardens, NY - (718) 846-2849