REVERSE RAFFLE TICKET PURCHASE

Welcome to the JRC Reverse Raffle 2022! - September 30, 2022 6:00 p.m. to 8:30 p.m.

EVENT SPONSOR - Pro Football Hall of Fame

SEE BELOW FOR:

ONLINE REGISTRATION

COMPLETE ONLINE REGISTRATION - BELOW

Registration Fee

First Name (Required)

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Last Name (Required)

Email (Required)

Phone

Address (Line 1) (Required)

Address (Line 2)

City (Required)

State (Required)

Zip (Required)

Cardholder Name (Required)

Credit Card # (Required)

Visa MasterCard American Express Discover

Expiration Date (Required)

Security Code (Required)

Visa®, MasterCard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Billing Zip Code (Required)

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

Thank you for your ticket purchase!

All proceeds from this event go to the JRC Adult Day Center!