NORTH OSHAWA LIONS CLUB ANNUAL DRAW

TICKET ORDERING FORM
For our 2011 Annual Draw --- This a 1968 Chevrolet Camaro SS (FOB Oshawa)
Please print off this form, fill it out and mail with your cheque, money order or on $20.00 or more VISA or Master Card information to:

North Oshawa Lions Club,
Stevenson & King PO Box 30521, Oshawa, Ontario, L1J 8L8

Tickets are $5.00 each, 3 for $12.00 or 6 for $20.00 CDN
Please make cheques or money orders payable to "North Oshawa Lions Club"

I would like ________________ tickets

Name: ________________________________________________________________________

Address: ______________________________________________________________________

City: _________________________________________________________________________

Province: ____________________________ Postal Code: ___________________________

Telephone: (_____________)______________________________________________________

If paying by VISA or Master Card please fill in the following:

VISA ___ or Master Card ___ number: _______________________________________________

Expiry Date: ____________________________________________________________________

Name as it appears on card: ________________________________________________________

Signature: __________________________________________ Date: _____________________

We thank you for your support in our fund raising project and wish you good luck.