Raffle Registration Form

Raffle Registration Form
Organization Name
Type of account where proceeds from this raffle will be deposited.

University accountWIU Foundation account
Contact Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of Raffle Drawing

MonthDayYear
Date
Raffle Prize Description
Anticipated Prize Value
Price of One Raffle Ticket
Should be Empty:

Contact Information