Make-A-Wish Helmet Raffle Ticket Order Form
Print Out - Fill Out ( LEGIBLY) - Mail In (US Funds Only)

Please send me _____ Make-A-Wish Raffle Tickets

• Send me _____  tickets @ $5.00 ea
• $ ____________ Total Cost Tickets
• $ ____________ Postage $.39

Please send me _____ Make-A-Wish Raffle Tickets

• Send me _____  groups of 5 tickets for $20.00
• $ ____________ Total Cost Tickets
• $ ____________ Postage $.39

Total: ________________

There will be two winners. The first ticket drawn will get Jim Murphy's
World Championship helmet, the second winner will get the signed Mike Boyd helmet.

______________________________________________

Name: ___________________________________________________________

Address: _________________________________________________________

City: _____________________________________________________________

State: _______________________________________ Zip Code: ____________

Phone (Days): _____________________________ (optional)

e-mail Address: ____________________________________________________

Select Payment Type: (include payment with form)

Check Payment Type: _____Cashiers _____ Money Order _____ Certified Check
_____ Personal Check

Make checks payable to: Bill Pitts

Mail Order Form To:
1320 Charities
Bill Pitts
3127 Del Rey Avenue
Carlsbad, CA 92009

E-mail: Helmet Raffle

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