SZBE 2024 Raffle Order

* Name of Canvasser:

* Full Name:

* Email Address:

This email will be used for confirmation emails, as well as distribution of tickets.

Tax Receipt Name (if different):

* Address:

* City:

* Postal Code:

* Telephone Number:

Are you a member of Shaare Zion Beth-El?

YesNo

* How many tickets would you like to purchase?

1 Ticket = $125

*$100 Tax Deductible

Agree to split?

YesNoYES means that, if you are one of the final TWO chips in the draw, you agree to split the grand prize of $16,000 and the runner up prize of $1,800, total $17,800, with the other final chip holder (if they also said YES) and you will both automatically win $8,900.
NO means that you refuse to split.

Total Amount Owed:

Wed, 1 May 2024 23 Nisan 5784