UH, Loie, dear....the form is for questions. You need fill nothing out to be eligible to win:
Qualified tourists who travel to Belize via the Phillip Goldson International Airport, between July 15 and November 15 2001 are eligible to win money back (up to US$1,000) on their airfare. There will be one prize given every month beginning August 15th and the winners will be drawn from the names of tourist arrivals entering Belize at the Phillip Goldson International airport during the previous month. All qualified arrivals will automatically become eligible to win.
Happy to help out, dear!