17th Annual New England Parrot Head Convention Raffle
to benefit Compassionate Care ALS.

Drawing on March 10, 2012, you do not need to be present to win.

Tickets $25 each or 5 for $100. Minimum 350 tickets sold.

Tickets will be mailed to individuals who purchase online

To purchase raffle tickets please fill out the following information:

Name:
Address:
City:
State:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX USVI UT VA VT WA WI WV WY
Zip:
Phone:
E-mail:
Number of Raffle Tickets ($25 each or 5/$100):

Once you submit this information, please fill in the dollar amount of the number of tickets you wish to purchase on the paypal page that follows.