Versiti - New Year Same Lifesaver Social Sweepstakes Form

Sweepstakes Entry Form

Entry Form

To enter the 2026 New Year, Same Lifesaver Sweepstakes without donating (“AMOE”), complete the below online entry form during the Sweepstakes Period. By completing the online form, you will receive one entry into the Sweepstakes.

* First Name

* Last Name

* Date of Birth

Phone Number

* Email

Address

* Address

Apartment or Suite

* City

* State

Illinois Indiana Michigan Ohio Wisconsin

* ZIP

* Consent Agreement

* Fields are required.