PROXY FORM: This form must be completed by the winner in order to proxy their Hawaiian Holiday trip prize and must be submitted no later than November 3, 2025.

Today's Date

YYYY

By completing this form, I, the original prize winner acknowledge that I will not attend the Hawaiian Holiday event (Print original prize winner's First and Last Name)

As the original prize winner, I agree that my Proxy will attend the event on the Big Island in my place. The Proxy's name is (Print the Proxy's First and Last Name below)

Proxy Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Proxy Email

Proxy Phone

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Lucky Pik Game Show Proxy Approval

Winners will each have a chance to play the Lucky Pik Game Show during the event on Dec. 17th for a chance at a portion of $50,000. Winners will need to acknowledge and agree that they are allowing their proxy to participate in the game show on their behalf. By clicking "I agree" below, you give your proxy permission to participate in the game show on your behalf and acknowledge that you will receive all cash winnings and the proxy is not eligible for any cash prizes.

I approve and give consent to my Proxy to play on my behalf

Terms and Conditions

All taxable cash prize won during the Lucky Pik Game Show will be paid to the prize winner and not the proxy. The winnings will be subject to federal and state tax withholding by the lottery for the Hawaiian Holiday promotion taking place on December 12 - 18, 2025. – A Proxy must be identified by the original prize winner prior to booking any travel arrangements with Atlas Experiences. Proxies are not eligible for any cash prizes awarded during the nightly cash giveaways or during the Lucky Pik Game Show even in the event they participate on the winner’s behalf. The original prize winner is only eligible and will be automatically entered into the drawings announced during the event and will be notified of any winnings post event. Once a proxy is identified, the winner will not receive any event emails and they will be sent directly to the proxy. By agreeing below, I acknowledge and agree with all terms and conditions. By agreeing below, I acknowledge and agree with all terms and conditions.

I agree to the terms and conditions.

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