Form printed at DeaseLake.net
YES I WANT TO BE A WINNER! Dease Lake Recreation Centre 11th Annual ATV Raffle	Licence No. TR-RG25946
Please Send me ____ @ $25 Each, 3 for $65, or 5 for $100. My Cheque is enclosed, payable to Dease Lake Rec Society
My Visa No.:_______________________________________________________	Expiry Date: ______________________________________
Name of Cardholder: ________________________________________________	Signature: ________________________________________
Name(s) you would like on ticket(s):_________________________________________________________________________________________
Address:_______________________________________________________________________________________________________________
Home Phone No:_________________________ Work No:_________________________ Email: _______________________________________
Mail to: Dease Lake Rec Society, Box 359, Dease Lake BC, V0C 1L0 or Fax 250.771.3572 or 250.771.3572 for messages Draw Date: September 08, 2006, 5:00pm