SZBE 2023 Raffle Order

Name of Canvasser:

Name:

Email Address:

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

Tax Receipt Name:

Address:

City:

Postal Code:

Telephone Number:

Are you a member of Shaare Zion Beth-El?

YesNo

* How many raffle tickets would you like to purchase?

1 Ticket = $136

*$100 Tax Deductible

Agree to split?

YesNoIf you are one of the final TWO chips in the draw, do you agree to split the grand prize and runner up prize
( each chip automatically wins $9900) or take a chance and spin to win the full $18,000.

Total Amount Owed:

Fri, 26 April 2024 18 Nisan 5784