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: [email protected]
