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We need your Help... Become a Street Impact ~ America Member and help Youth!

       Join our Street Impact ~ America Network! :: Help Youth across America!

    		   
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Group Involvement information ...

Please fill in the sections below. Once you have completed this form, please click on the 'Submit' button. If you make a mistake, please make your corrections as necessary. If you need to clear the form, please click on the 'Reset' button.

Send us an e-mail message. . . Or print out this form and fax this to us. Further details for the raffle will be posted in the near future.
Please note: ALL fields are required! -- Thank you "

*All fields are required! 

            1. Raffle Participation . . .
YES, We will participate in Street Impact Car Raffle.

This is our organization's first year participating in the raffle.

 Please send us information.

            2. Contact Information . . .
 
* Contact Person's Name:
  
* Contact Person's Address
  
* City:
  
* State:
  
* Postal Code:
  
* Country:
  
* Phone - Country Code:
  
* Contact Person;s Phone Number:
  
* Contact Person's E-mail Address:
  

            Organization Information . . .
 
* Organization's Name:
  
* Mail Address:
  
* Address:
  
* City:
  
* State:
  
* Postal Code:
  
* Country:
  
* Phone Number:
  
* E-mail Address:
  

I would like our organization's website posted as a link on this raffle website at no charge.

3. Type of Organization
(e.g. Church, School, Civic, Sorority, Fraternity)  

4. Tax Information. . .
Please check if you are chartered as a non-profit organization or not for profit.
Please check if you are tax-exempt.

5. Ordering Tickets . . .

We wish to order tickets for the Sreet Impact ~ America Car Raffle. We understand that each ticket is to be sold at $20.00... that every 5 ticket group is $100.00. A special... buy 10 tickets and get one FREE! For every 100 tickets you become a sponsor. You that are a sponsor for "We Care that You Care!" campaign. Sale of tickets is void where prohibited. Income tax, license, tags and title not included. Winner must be eighteen years or older. Organization is 100% accountable for tickets obtained. Unsold tickets not returned must be paid for.


6. The officers of our organization are:     

7. (For contact person)

I affirm that no individual or group other than the above named organization shall benefit either in whole or in part from the proceeds of this raffle. I also affirm that I fully understand the procedures and dates mentioned above.

8.. Please write any additional message
(fewer than 5000 characters)

 

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Thank you!

 

Request More Information:

     Send us a request for more information. In your request you can ask for more details on the raffle or request to have someone contact you directly about the raffle.

   
© 2011 Street Impact ~ America Raffle!