Buy Your Tickets TODAY For The Georgia Healthy Family Alliance $10,000 Draw Down


Buy Your Tickets TODAY For

The Georgia Healthy Family Alliance

$10,000 Draw Down

Draw Down Raffle Ticket Order Form

Name___________________________________________________________________

Address_________________________________________________________________

Cell Phone__________________________ Email:________________________________

  Indicate Number/Type of Ticket Below

     _____ Draw Down Ticket (s) @$50 each

     _____ Draw Down Ticket(s) w/ *Insurance @ $75 each

   (*If ticket is one of the first 50 drawn, it will be returned to Draw Down barrel for a second chance)

    ( ) Cash

    ( ) Check payable to Georgia Healthy Family Alliance

    ( ) Credit Card ___________________________________ Billing Zip___________

     Expiration __________________   V-CODE ______________________________

Please check all that apply (even if you plan to attend)

_____If my name is one of the last 4 names remaining and the other 3 remaining names agree, I wish to split the $10,000 four ways winning $2,500.

_____If my name is one of the last 3 names remaining and the other 2 remaining names agree, I wish to split the $10,000 three ways winning $3,333.33.

_____If my name is one of the last 2 names remaining and the other remaining name agrees, I wish to split the

$10,000 two ways winning $5,000.

            I do not wish to split at any level.

_____If I win I would like to donate $_____ to the Georgia Healthy Family Alliance

 

GHFA 3760 LaVista Road, Ste. 100 Tucker, GA 30084 ~ Georgia Raffle License No. 2015033