Opportunity Partners 2024 Gala Raffle Tickets

Name*
First Last
Name on Ticket (if not the same as above):
First Last
Number of Tickets ($100 Each)*
Total Amount $*
All purchases must be made with a debit card, check, or cash (credit cards not accepted):*
- Cash
- Debit Card
- Check
Purchaser/Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Debit Card Information (If you selected Debit Card above, please fill out information below)
Name on Debit Card Card # Expiration Date Security Code
Check Information (If you selected Check above, please use the information below to fill out/mail your check):
Please mail checks to the address above

On Memo Line: Raffle Ticket
Cash Information (If you selected Cash above, please use the information below to mail in your payment):
Please mail cash to the address above
Purchaser Email*
Purchaser Phone Number*
Notes: