Raffle Form

First Name Please provide your first name; it may contain only numbers, letters, spaces and - , . '

Last Name Please provide your first name; it may contain only numbers, letters, spaces and - , . '

Phone Please provide your phone number in the format xxx-xxx-xxxx.

Email Please provide a valid email address.

Option 1 ~ Raffle Ticket Packages

$50 Package Includes 1 strip (5) of Special (Orange) Tickets and 6 strips (36) of Regular (Yellow) Tickets

$100 Package Includes 3 strips (15) of Special (Orange) Tickets and 8 strips (48) of Regular (Yellow) Tickets

$200 Package Includes 7 strips (35) of Special (Orange) Tickets and 12 strips (72) of Regular (Yellow) Tickets

$300 Package Includes 10 strips (50) of Special (Orange) Tickets and 20 strips (120) of Regular (Yellow) Tickets

$500 Package Includes 17 strips (85) of Special (Orange) Tickets and 32 strips (192) of Regular (Yellow) Tickets

Regular (Yellow) Ticket Strips (1 strip of 6 for $5.00)

Regular (Yellow) Ticket Cost

Special (Orange) Ticket Strips (1 strip of 5 for $20.00)

Orange Ticket Cost

Total # of Special (Orange) Tickets

Total # of Regular (Yellow) Tickets

Pre-Purchase Total:

Payment Method