# of Tickets ($325 each): 0 1 2 3 4 5 6 7 8 9 10 11 # of Raffle Tickets ($40 each): 0 1 2 3 4 5 6 7 8 9 10 11 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: Billing Last Name: Street: Apt #: City: State: Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: Phone: E-Mail: Ticket Total: $0.00 Raffle Total: $0.00 Date: 4/19/2018 Credit Card #: Exp. Date: MM 01 02 03 04 05 06 07 08 09 10 11 12 YY 18 19 20 21 22 23 24 25 26 27 28 29 Security Code: