$100,000 Mega Raffle Credit Card Information
to Reserve Your Tickets

 

    Name:
         
    Address, City, Zip:
         
    Phone:
         
    School Family: YesNo
         
    Email Address:
         
    1 ticket $50.00 or 3 tickets for $100.00
         
    Number of tickets:
         
    Credit Card # (Mastercard and Visa only):
         
    Expiration Date:
         
    Amount to be Charged: