50/50 Raffle Club

Name: _______________________________________________________________

Class Year: __________________      Telephone Number: ______________________ 

Address: ______________________________________________________________

City, State, Zip: _ _______________________________________________________

$120.00 is enclosed for the entire year: ________ (Full year runs from July to June)

$10.00 is enclosed for the months of: _______________________________________

Total Enclosed $__________________

To charge the above, please provide the following information and authorization

VISA/MC Account #: ________________________________________ Exp. ______

Cardholder Signature: ___________________________________________________

Drawing will be held on the 1st of each month.

(Payments received after the 1^st of each month will be held until the following month)