NSSR
BRIGHT ROD RUN 2010
RAFFLE TICKET PURCHASE FORM
Drawn 7th November 2010

Full Name:
Street Address: Suburb:
State:                                                    Postcode:
Contact Number:       Email:
(Please include area code)


34 Tudor body raffle tickets
* $5.00
Total Amount $


NOTE: If you are paying by cheque, please print an extra copy of this page and click the submit button for
address information and payment summary. You will need to send in a copy of this form with your cheque.

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For enquiries contact
aplusit@tpg.com.au