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Raffle Registration Form 2017

Raffle Registration Form 2017

raffle_banner17.jpg

Every ticket counts! Buy yours today.

COUNT ME IN!!!

Yes I’d like to support Chabad Jewish Center by participating
in the Community Partnership raffle campaign.

I am purchasing
entries for $

1 Entry $180 * 3 Entries $500 * 4 Entries $600 * 5 Entries $770 * 10 Entries $1,000 * 15 Entries $1,500

First Name*
Last Name*
Address*
Address Line 2
City*
State*
Post Code*
Country
Phone*

Email*

Please charge my Credit Card

Card Type
Card Number

Expiration Date

Name on the card

I would like to pay by check. (Please mail check to: Chabad Jewish Center, 3977 Hunt Road, Cincinnati, OH 45236)

Who can we thank for recommending the purchase of this (these) ticket (s)


Comments: (please indicate here if you would like to pay in installments)

Official notification including ticket number will be issued on receipt of your form.
Winner need not be present to win
Raffle drawing date July 9, 2017.

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