Four Core Values of the YMCA
Jefferson City Area YMCA
Auction Raffle Ticket Form

Please complete this form to purchase raffle tickets for the YMCA Auction on March 28, 2009.

Please note the following:

  • All items marked with an asterisk (*) must be filled out to complete your purchase.
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Security
Your Information
Please enter the following information for the person completing this form.
* First Name:
* Last Name:
* Street Address:
* City:
* State:
* Zip:
* Phone:
( ) -
* Email Address:

Your Information
You will receive an email confirmation of your reservation.
Auction Raffle Tickets
Trip Raffle - $25/ticket or 5 tickets for $100
This trip for 2 includes airfare, 4 days, 3 nights at a downtown Manhattan hotel and tickets to a Broadway show. Alternate trip may be substituted. Or the winner can take $1,500 in cash. Need not be present to win.
x $25
Taste of Jefferson City - 3 tickets for $25
This gourmet basket, valued at more than $800, is filled with assorted wines and gift certificates to area restaurants. You do not need to be present to win.
x $25 (1 = 3 tickets, 2 = 6 tickets, etc.)
Due to generous donations like yours, in 2009, the YMCA was able to provide services such as child care, swimming lessons, soccer, and more to 600 children who otherwise could not afford it.

Raffle Tickets
Raffle tickets can also be purchased the night of the auction.
Credit Card Information
Your credit card will be charged the appropriate amount based on your selections above.
* Credit Card Type:
* Credit Card Number:
- - -
* Credit Card Verification Number:
(On back of credit card)
* Expiration Date:
/
* Name on Credit Card:

Credit Card
You must complete all information for us to process your online registration.




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