Reverse Raffle 2023 Registration

REVERSE RAFFLE 2023
to benefit the JRC Adult Day Center

$60 - Raffle Ticket & Tailgate-Style Appetizers
$50 - Raffle Ticket ONLY

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)

Expiration Date (Required)

Security Code (Required)

cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

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

Attending Event?

Reverse Raffle Attendance Reservations - Below quantity (Required)

Thank you for your ticket purchase!

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