Drawing will take place atJDRF Central Jersey Chapter • 740 Broad St, Shrewsbury, NJ 07702

October 16, 2015 • 10:00 AMProceeds to benefit JDRF. Winner need not be present to win. No cash will be given in lieu of prize.

Winner subject to pay state and federal taxes. For additional tickets contact JDRF at 732-219-6654.PERMIT #: 2015-05 • NJ LGCCC ID #: 360-5-30028

Name:____________________________________________________________________________________________

Address: __________________________________________________________________________________________

City/State/Zip: _______________________________________________________________________________________

Phone: ___________________________________________________________________________________________

Please send me _________ raffle ticket(s) for a chance to win the 2015 Audi Q3 2.0T Quattro Tiptronic. Total amount due: $ ___________________

q Check enclosed Charge my credit card: q MC q Visa q Amex q Discover

Account #: ________________________________________________________________ Exp. Date: __________________

Authorized Signature: __________________________________________________________________________________

HELP US CREATE A WORLD WITHOUT TYPE 1 DIABETES

$100 per ticket for a2015 AUDI Q3 2.0T QUATTRO TIPTRONIC

This car generously donated by

Return this form with payment to:JDRF Central Jersey Chapter • 740 Broad St, Suite 4, Shrewsbury, NJ 07702For more information, please contact Stacy DiArchangel • P: 732-219-6654 • F: 732-219-8722 • Email: sdiarchangel@jdrf.org