Raffle tickets

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

How would you like to purchase your tickets?

E-transferCredit Card (online through PayPal)

Purchase tickets online - no PayPal account needed

Single ticketOne single raffle ticket

$10.00CAD Quantity
Item subtotal:$0.00CAD

3 for 203 raffle tickets for $20

$20.00CAD Quantity
Item subtotal:$0.00CAD

Total

$0.00CAD

After submitting this form, you will be sent an email that contains the email address required for the e-transfer. Please make payment to that email address within one business day

Please choose the quantity of tickets you would like to purchase.

	Quantity
Single ticket $10
3 tickets for $20

Single ticket calculation

3 for 20 calculation

Amount owed

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Alzheimer Niagara Raffle Tickets