Enter to WIN a NASCAR VIP Motorcraft
Racing Experience of a Lifetime!
Donations benefit JDRF, the leading global
organization funding type 1 diabetes (T1D) research.
RAFFLE TICKET REQUEST FORM
$10/TICKET
CONTACT AND BILLING INFORMATION
Your Name ______________________________________________________________________________________
Address _________________________________________________________________________________________
City / State / Zip ________________________________________________________________________________
Phone ____________________________________ Email Address _______________________________________
REQUEST RAFFLE TICKETS
Number of tickets requested: _________
PAYMENT INFORMATION
Credit Card Number _______________________________________________ Expiration __________________
Cardholder Name _______________________________________________________________________________
Cardholder Signature ____________________________________________________ Date ________________
RETURN TO
EMAIL: [email protected]
Please use subject line:
VIP MOTORCRAFT RAFFLE REQUEST
MAIL TO:
Ford Conference and Events Center
Attn.: JDRF/NASCAR Raffle
1151 Village Road
Dearborn, MI 48124
The NASCAR VIP Motorcraft Racing Experience of a Lifetime includes:
·Round-trip airfare for the winner and three guests to Miami, FL
·Three nights hotel accommodations
·Honorary pit crew status for the winner with the #21 Motorcraft and Quick Lane Ford Fusion,
with exclusive team, driver and “hot pass” track access
·Tickets to the Ford EcoBoost 400 on Nov. 20, which will decide the
2016 NASCAR Sprint Cup Series Champion
·A VISA gift card for meals and car rental
·Motorcraft autograph and apparel package
Drawing – September 30, 2016 Winner will be notified by phone, email or mail.
Winner will be responsible for taxes.
JDRF is a 501(c)(3) nonprofit charitable organization. (Tax ID# 23-1907729.) Your contribution is tax deductible to the extent provided by law.
Raffle License #R37427