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# of Tickets ($325 each): |
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| # of Raffle Tickets ($60 each): | |
| If you are attending the Gala, your raffle ticket stub can be picked up at registration. If you are not able to attend, we will send your ticket stub by mail. | |
| Billing First Name: | |
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| Street: | |
| Apt #: | |
| City: | |
| State: | |
| Zip: | |
| Phone: | |
| E-Mail: |
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| Ticket Total: | $0.00 |
| Raffle Total: | $0.00 |
| Date: | 3/5/2021 |
| Credit Card #: |
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| Exp. Date: | |
| Security Code: | |
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