2009 Evening of Chocolate and 50/50 Raffle Fundraiser
Return completed form to: Safe Passage, P.O. Box 621, DeKalb IL. 60115 Attn: Susan Phone: 815-756-7930
First Name __________________________ Last Name __________________________________________________
Address: __________________________________ City __________________________
State ______ Zip ________
Phone: ( ) _____________ e-mail:_______________________________________________________
Please reserve __________ Event Tickets @ $20.00 each…………………………..Total
$______________
Please reserve __________ 50/50 Raffle Tickets @ $10.00 each, 6 for $50.00,
or 15 for $100.00……Total $_____________
**Tickets will be forwarded to you by return mail.
Total Amount Enclosed $__________