WestJet Raffle Order Form
Date:
Contact Name: Name:
Street:
City:
___
Prov:
_________ Postal Code: ____________
Email:
Phone#: (
Quantity:
1 x Raffle Ticket @ $10 each: $
Quantity:
3 x Raffle Tickets @ $20 per pack of 3: $
)
Total amount of Order: $
Eligibility Confirmation *
I am 19+ and in the province of British Columbia when placing this order
Please check the boxes to confirm your eligibility. Purchasers must be in the province of British Columbia when the
tickets are purchased.
Amount: $
 Cheque by mail (make cheque(s) payable to: The Leukemia & Lymphoma Society of Canada)
 Pay in person
 Credit Card:
Name on the Credit Card:
Tel.: (
)
________________________________________________________________________________
□ VISA □ MC □ AMEX Card #:
/
/
/
Exp:
/
Tickets will be mailed in accordance to the contact information and quantity indicated
above & upon payment in full (based on available tickets/while quantities last).
If you would like your tickets to be emailed to you and to cut of postage costs please tick here:
 Yes Please email tickets to me
Chances are 1 in 2900 (total tickets for sale) to win a grand prize
BC Gaming Event Licence #86985
Problem Gambling Help Line 1-888-795-6111
www.bcresponsiblegambling.ca
Know your limit, play within it.
The Leukemia & Lymphoma Society of Canada, BC/Yukon Office – 303 – 1401 West Broadway, Vancouver, BC, V6H 1H6
www.llscanada.org + Tel: 604-733-2873 Toll Free: 1-866-547-5433 + Fax: 604-733-2848
Established in 1955 + Registered Charity BN 10762 3654 RR0001
19+