Please fill out the form below.
The email address you enter in this form will be the email used to contact you throughout this competition.
Friends@JimBrickman.com will be the email address sending information to you, please make sure to save this address in your contacts.

Once you fill out this form and click on the “Register” button below,
you’ll be taken to a page to pay the $50 entry fee.

Name(Required)
MM slash DD slash YYYY
Address(Required)
Consent(Required)
This field is for validation purposes and should be left unchanged.

Once you fill out this form and click on the “Register” button,
you’ll be taken to a page to pay the $50 entry fee.