Raffle Entry Form

VIRGINIA CITY RED CHAIR RAFFLE

 

PLEASE PRINT LEGIBLY

 

First Name: __________________ Last Name: ____________________

Email Address: ______________________ Phone: _________________

Mailing Address: ____________________________________________

 

____ tickets @ $25/ea (1-3)

____ 5 tickets for $100

 

___ check enclosed

___ charge my credit card

            Credit Card Number: ___________________________________

            Expiration: __________ CVC code: ___________

 

REMIT TO:

Bozeman Public Library Foundation

626 East Main Street

Bozeman, MT 59715