Let’s Play for the Playground!
Thank You for Supporting Whittier School PTA!
CASH BAR! ATM on site!
Open Seating! Food!
Doors open at 7pm
Main Floor Games start at 8pm
There will be plenty of fun and laughs this evening. Whether you are competing with others at
table games, participating in the Main Floor Games or just watching,
you are sure to have a great time!
Each contestant of the Main Floor Games (participation is optional!) will receive a participation
ticket for a chance to win a Main Floor Game Player Grand Prize.
Each winner of a Main Floor Game will win a prize!
“Heads or Tails” will be played between games 2 & 3
(Must purchase a Flashing Star Necklace for entry - Winner takes an iPad Mini)
50/50 Raffle drawing
Basket Raffle drawing (Includes 7 Class Baskets!)
~ Silent Auction Items will have staggered closing times which will be posted at event ~
~ Winners Announced at 11:00pm ~
Tickets Prices & Payment Details
Raffle Tickets to be used for:
Basket Raffle (7 Classroom Baskets included)
Ticket Cost: $5/each, 5 for $20, 10 for $30
Please write your name & phone # on each ticket before using.
Raffle Tickets to be used for:
50/50 Raffle
Ticket Cost: $5/each, 5 for $20
Please write your name & phone # on each ticket, then place in box at the raffle table.
Flashing Star Necklace:
Heads and Tails Game: Each favor is one entry into the game! Purchase multiple favors to stay in
the game. Winner takes home an iPad Mini!
Cost: $10
Methods of payment:
Credit Card, Cash or Check. Credit Cards encouraged (Authorization Form required, see attached).
Visa, MC, Discover accepted. Payment for ALL auction items is due at the end of the evening at
the Welcome Table.
Please note that raffle ticket purchases are not tax-deductible.
Amounts paid over the estimated value of auction items are tax deductible.
BASKET RAFFLE
Drop your GREEN raffle tickets in the bins for a chance to win one of these amazing packages!
Ticket Cost: $5/each, 5 for $20, 10 for $30
Please write your name & phone # on each ticket before using.
Classroom Baskets
CB 1 - Kindergarten Basket ~ Mrs. Plepel
 American Girl – Girl of the Year – Grace Thomas
 Grace’s Welcome Gifts
Est Value: $160
CB 2 - 1st Grade Basket ~ Mrs. Richards and Ms. Pawlowski
 Blackhawk jerseys; one adult and one kid’s
 Includes custom naming on back of jerseys
 Gift receipts included to ensure proper sizing for winners
Est Value: $335
CB 3 - 2nd Grade Basket ~ Mrs. Sullivan and Mr. Swade
$220 Nordstrom Gift Card
Est Value: $220
CB 4 - 3rd Grade Basket ~ Mrs. Modine and Mrs. Jurenik
Apple TV: Gives you access to the best 1080p HD content including blockbuster
movies, hit TV shows, live sports, music, photos and more – right on your HD
TV. You can even play content from your iOS device or MAC on TV using
AirPlay. HDMI cable included.
Est Value: $128
CB 5 - 4th Grade Basket ~ Ms. Carey and Mr. Miller
 Dells weekend at Wilderness Resort
 Two night stay in standard double queen sofa rooms for up to 6 guests.
 Includes use of waterparks, arcades, and dry play park.
 Valid anytime, except holidays & certain peak periods.
Est Value: $250
CB 6 - 5th Grade Basket ~ Mrs. Lyons and Ms. Edwards
Razor Ripstick Ripster electric scooter
Est Value: $160
CB 7 - 6th Grade Basket ~ Mrs. Krygeris and Mrs. Zagorski
iFly Family Package: Up to 5 people, 10 flights or 5 double length flights
Est Value: $230
Thank you to all who donated to the Classroom Basket Challenge.
Your donations made these great prizes possible. Thank you!
Other Baskets
BA 1 - Photography Basket
 Fuji Film instant camera
 Twin pack instant Film
 Camera Accessory bundle kit
Est Value: $140
BA 2 – Dining Out
 Stir Crazy $50 GC
 Thai Café $50 GC
 Uncle Julio’s $25 GC
 Baked Apple $25 GC
Est Value: $190
BA 3 - Gardener Basket
 $250 gift card to Hinsdale Nurseries
 4 Patio Pillows
 Citronella candle from Soy Enjoyable
Est Value: $285
BA 4 - ?Mystery? Basket
What does this mystery box hold? The sky is the limit. Guaranteed value of at
least $100. Will you take a chance???
Est Value: At Least $100!
BA 5 – Summer Fun
 Lost Mountain Adventure golf-2 passes
 Raging Waves 2 weekday passes 60
 Kane County Cougars game-4 regular priced reserved seat for the 2015 season
 Lemonade stand & Dispenser
 Dairy Queen – 20 cones
Est Value: $200
BA 6 – Dinner and a Movie
 AMC 2 Tickets + Season’s 52 $50
 4 Hollywood Cinema 32 + Home Run Inn $25
 20 Redbox Rentals + $25 Jason’s Deli GC
Est Value: $180
BA 7 - Swimmers Basket
 Bear Paddle $100 gift basket
 6 passes to Sea Lion
Est Value: $180
BA 8 – House Hop Dining
 Tap House 2 $25 GC
 Country House 2 $25 GC
 Emmett’s Ale House 2 $25 GC
 Sushi House $40 GC
Est Value: $150
BA 9 – Style Studio
 3 Vera Bradley bags
 Grand Traveler Blue Bayou
 Neoprene Organizers Blue Bayou
 Lunch Bunch Blue Bayou
Est Value: $120
BA 10 – Organize
31 Rolling Cooler filled with goodies
Est Value: $120
BA 11 – Rainy Day
 Seven Bridges - 4 coupons for free skate and rental
 Lombard Roller Rink – 10 One time passes
 DuPage Children's museum-6 One time pass
 Pinstripes (in Oakbrook) $25 GC
 Family pass to Museum of Science and Industry
Est Value: $150
BA 12 – Summer Camp at The Academy of Art & Music
Certificate for 1 week of Summer Camp
Choose from a variety of classes like Show Choir, Dance camp, Broadway
Bound, Art Camp, Sculpt Camp
Est. Value: $255
Experiences – Sign Up at the Event
E 1 - Scavenger Hunt
Join your friends for a fun scavenger hunt, snacks and playtime in Randall Park
Date: May 17th, Time: 3-4 pm, Location: Randall Park
Cost: $10 per student
Thank You Host Families: Rosenberg/Brezina
E 2 - Mother/Daughter Fun Night
Spend an evening out with your daughter making memories you will both
cherish! Get your girly dance on with your daughter and get ready for some
fun games and contests as well! Boys aren't the only ones who can play a
good game of dodge ball... Join us in the Jaguar Jungle with DJ Coach Josh,
where there's sure to be lots of laughter and a fun-filled evening. We will
capture this special moment with a photo keepsake for you to treasure. Light
refreshments will be served.
Date: May 7th, Time: 6:30-8 pm, Location: Whittier Jaguar Jungle
Cost: $30 per student
Thank You Host Families: Kuelthau/Dobrez/Johnson
E 3 - Kids Running Club
Kids will learn safe and fun ways to condition for running distances, will have a
chance to meet and learn from DGN track athletes, and have the opportunity
to sign up as a group for a local 5k (additional cost/date/location TBD). What
better way to get your child up and running!
Date: 4/10-5/15 (6 Fridays), Time: 3:00-3:45, Location: Whittier School
grounds and surrounding area
Max: 20 2nd- 6th graders
Cost: $30 per participant
Thank You Host Families: Cleveland/Potter
E 4 - Toga Party
Strip your beds and join us in the Greek tradition at this year's not to be
missed Toga Party! Heavy appetizers, beverages and a GREEK time provided.
All you need to bring is your toga! "Toga! Toga!"
Date: August 28th, Time: 7:30 pm, Location: Toth Backyard
Cost per participant: $30 (Adults only)
Thank You Host Families:
Toth/Hagen/McTigue/Ennis/Williams/Johnson/Schultz
E 5 - Fair Game Party
Enjoy an afternoon of board game fun at Fair Game!
Date: April 27th, Time: 4-6pm, Location: Fair Game
Max: 15 (4th-6th graders)
Cost: $15 per student
Thank You Host Families: Fair Game/Stein Family
E 6 - Mother’s Day Craft
Roses are red, violets are blue, let your kids show how much they love you!
Participants will make a one-of-a kind gift for Mom's special day.
Date: May 6th, Time: 3-4 pm, Location: Jaguar Jungle
Cost: $10 per student
Thank You Host Families: Gianelli & Rausch
E 7 - Family Movie Night
Join us for a good old fashioned back yard movie night at the Mielke's house on
Saturday, June 13. We'll provide the popcorn and some adult and kid friendly
beverages (beer and margaritas for those 'of age'...water and lemonade for those
not). You simply bring the family and some blankets to sit on. Enjoy a movie under
the stars with the whole family! If you have allergy concerns, please contact a host
family. Movie to be named later...typically a PG rated offering.
Date: June 13th, Time: Movie starts at dusk - yard opens at 7pm to hang out,
Location: Mielke backyard Max: 35 families Cost: $30 per family
Thank You Host Families: Eber/Mielke/Rosenberg
E 8 - Ultimate Frisbee
Sign up for this "ultimate" experience and learn the skills of ultimate frisbee - a
non-contact sport that combines the best elements of soccer, football, and
recreational frisbee. Included in the 1 1/2 hours of instruction will be a brief
DISCussion of the game rules followed by hands-on skill-building. Water and fruit
will be provided. Please advise regarding any fruit-related allergies in advance.
Date: April 28th(*Rain Date: May 5th), Time: 3-4:45 pm, Location: Whittier
Grounds Max: 30 (1st-6th graders) Cost: $15 per student
Thank You Host Families: Donat
E 9 - Mixology Party – Ladies Night
Get ready to "mix" and mingle at this ladies night in! You will learn how to infuse
liquors and make some creative cocktails while also having time to snack and
socialize!
Date: May 29th, Time: 7pm, Location: Rosenberg home Cost: TBD
Thank You Host Families: Hardy/Rosenberg
E 10 - Father/Son Fun
Dads, grab your son(s) for some male bonding time! Details to follow soon!
All Things Whittier
WH 1 - Breakfast with the Principal - Michael Krugman
Start your day having breakfast with Mr. Krugman. The highest bidder, along
with a friend, will join Mr. Krugman for breakfast at Egg Harbor. This is your
opportunity to find out whatever you want to know about Whittier. After
breakfast, we will return to Whittier for the rest of the school day. A date will
be determined once a winner is selected.
Opening Bid: $20
WH 2 - Lunch Party! - Julie Plepel
Four Kindergarten students will have the opportunity to have lunch at school
with Mrs. Plepel. It will be a "Lunch Party!" A date will be determined once
winners are chosen.
Opening Bid: $10
WH 3 - Pizza & Play with the Teachers! - Jenna Carey, Eric Miller, Skyelar
Edwards, Cheryl Lyons, Ericka Zagorski and Deb Krygeris
Join Ms. Carey, Mr. Miller, Miss Edwards, Mrs. Lyons, Mrs. Zagorski & Mrs.
Krygeris for some after school FUN! We will play some games together and
have a pizza party! Pick one friend to join you! Let's PARTY!
Date: Monday, May 18, 2015
Time: 3:00-5:00 pm Place: Whittier School
Who: 6 students (one from each class), along with 1 friend = 12 kids total
Opening Bid: $15
WH 4 - Staff vs. Student Kickball Game - Whittier Staff
Sign up for this experience and see of you can beat the Whittier Staff Team in
a good old fashioned game of kickball. 20 students will be able to take on the
staff and see if they can win the game. Be ready for an afternoon of fun!
Date: Thursday, May 21 Time: 3:00-3:45pm
Place: Whittier Intermediate Playground
Opening Bid: $15
WH 5 - Principal for a Day - Michael Krugman
The winner of this experience will spend the day with Mr. Krugman learning what
it is to be a Principal. Find out what happens at Whittier each day, and help out
with morning announcements, lunch supervision, reading to a favorite classroom,
and then have lunch with Mr. Krugman. A date will be determined once a winner
is selected.
Opening Bid: $25
WH 6 - Games and Popsicles Afternoon - Ashley Pawlowski and Heather
Richards
Join Miss P and Mrs. Richards for an afternoon of games and popsicles after
school. 4 students from each of their classrooms will be able to participate in this
fun event. A date will be determined once winners are chosen.
Opening Bid: $10
WH 7 - PE Teacher for a Day - Kyle Winter
The winner of this experience will spend the day with Mr. Winter leading PE
classes for the day. Learn what it is all about to be the Whittier PE Teacher. A
date will be determined once a winner is selected.
Opening Bid: $20
WH 8 - Staff/Student Gaga Tournament - Whittier Staff
Get your Gaga Game on and play with the Whittier Staff. 20 students will be able
to take part in this experience, as we mix up students and staff in the Gaga Pit for
a fun time.
Date: Monday, June 1 Time: 3:00-3:45pm
Place: Whittier Gaga Pit
Opening Bid: $15
SILENT AUCTION ITEMS
Check them out & write your bid on the sheets in front of each package.

Estimated Package values under $200 --> bid increment = $10

Estimated Package values $200 - $400 --> bid increment = $20

Estimated Package values over $400 --> bid increment = $25
Whittier Elementary School – LP4P
*All prize packages list approximate value at time of printing. We regret any errors or omissions.
SA 1 - MB Croft Photography
 One family or child photo session lasting approximately 45 minutes.
 (3) 8x10 prints of your favorite edited images
 $25 credit towards a custom photo book
Est Value: $250
Opening Bid $75
SA 2 – Kayak
Dagger Zydeco 11.0; 11 feet long
Est Value: $595
Opening Bid $175
SA 3 – Decompress
 Soy Enjoyable Candles
 Yoga by Degrees – Free Month of Yoga
 Buke's package – deep conditioning, blow dry style, make up application and
express pedi
 Trader Joe’s Coconut Body Butter
 Salon goodies: Matrix Biolage shampoo/conditioner, Wet Brush, OPI mini
mani kit, Design fx nail appliques, Essie base coat and top coat
Est Value: Priceless
Opening Bid $40
SA 4 – Tasting Devine
 Lynfred Wine Tasting in Wheaton for 10 people
 Soy Enjoyable wine bottle candle
Est Value: Priceless
Opening Bid $50
SA 5 – Get Fit Package
 Good Sam wellness center - 1 month Membership 76
 3 - 1/2 hr personal training session (for up to 3 people)
 Gracie Barra - one month of training (Jiu Jitsu) $150
Est Value: $325
Opening Bid $95
SA 6 – Adventure Realm
 4 person Adventure Realm & Amazing Chicago’s Funhouse Maze Experience.
Includes 30 minutes of MagiQuest with rental wands, game of Knight’s Quest
Laser Tag, 16” pizza, and 4 beverages
 4 All day passes for Amazing Chicago’s Funhouse Maze and 4 glow in the
dark bracelets
Est Value: $170
Opening Bid $50
SA 7 – Landscape Consult
Hulen Landscape Contractors, Inc is a full service landscape company in fine
garden design, construction and maintenance. Hullenlandscape.com
 You will receive a full landscape plan for front and backyard including a
consultation to establish your goals, final 3D presentation with budget and
materials list
Est Value: $700
Opening Bid $210
SA 8 – XRT
 2 tickets to upcoming Studio X live performance. Small, intimate
performance by a big name artist.
 Pick the performance of your choice between now and 2/18/16.
Est Value: Priceless
Opening Bid $50
SA 9 – Swim Party at Maple Hill Pool
 Maple Hill Pool Party - 10 kids and 2 adults
 One dozen cupcakes (with sprinkles) from La Petite Sweet
Est Value: $150
Opening Bid $45
SA 20 – Family Fun Package
 $200 Gift card to Boyne Resort
 One day waterpark admission for 4 people at Avalanche Bay at Boyne Mountain
Resort
Est Value: $350
Opening Bid: $100
SA 21 – 12/12 architects
4 free hours of architectural or interior design consultation in your home.
Est Value: $500
Opening Bid $150
SA 22 – Music Lover Package
 Jay Turser Electric Guitar, travel bag , and guitar stand from Tobias Music 230
 $50 off Tuition from Garage Band U ( first time students only (Tobias)
 From Modern Music:
 Drummer’s gift pack (pint glass, 3” mini practice pad, 5A black dip drumsticks)
 Guitar strings, picks, clip on tuner
 Harmonica and harmonica music book
 One private lesson for piano or violin from DG Public Library Corner of Grove and
Carpenter
Est Value: $355
Opening Bid $100
SA 23 – Disney
4 one day park hopper passes
Est Value: $496
Opening Bid $150
SA 24 – Date Night Package
 2 tickets to Paramount Theatre Show (your choice)
 Ballydoyle – 2 - $25 GC
 Heritage Florist $25 GC
Est Value: $200
Opening Bid $60
SA 25 – Lucky Strike Bowling Party
 2 hours of bowling for up to 8 people
 Complimentary shoe rental for the group
 Includes Mac & Cheese bites and Chips & Salsa
Est Value: $200
Opening Bid $60
SA 26 – Out with my BFF
 Pinot’s Palette – Painting class for 2 and one bottle of Chardonnay
 Chinn’s $50 GC
 2 Stained Glass lanterns from Artists Rose and Bill Jarecki
 2 gift certificates for the Fused Glass Pendant Class at Galleries Choice
Est Value: $225
Opening Bid $65
SA 27 – Home Decorating Package
 Walter E Smithe $100 gift card
 Sticks and Stones $50 gift card
 Eye to Eye Interiors - home paint color consultation $300 value
Est Value: $450
Opening Bid $125
SA 28 – Museums
 Science and Industry: Family Pass
 Field Museum: 4 General Admission Tickets
 Adler: 4 General Admission Tickets
Est Value: $200
Opening Bid $60
SILENT AUCTION ITEMS CONT.
SA 10-15 – “Comic Artwork”
Prints from Marvel and DC comic artist Greg Horn
 Wonder Woman
 Spiderman
 Batman
 Superman
 Thor/Ironman/Captain America
Est Value: $150 each
Opening Bid $45
SA 16 – Pet Lovers Package
 Happy Dog Barkery – bag of treats and $5 GC
 ”Paw-ty in a Bag” from Two Bostons – Custom party for 15 people and their
pets. Each attendee receives $10 to spend in the store that evening and a
container of puppy kisses treats. The winner receives $25 GC to spend in the
store that evening , container of puppy kisses, and a puppy cake mix
 $50 GC from grooming from All My Dogs
 GC for dog grooming from Kelly’s Waggin’ Wheels
Est Value: $150
Opening Bid $45
SA 17 – “Staycation”
 SpringHill Suites Marriott Burr Ridge-One free night in King Suite
 Dinner for 2 and a bottle of wine at Cooper's Hawk
Est Value: $300
Opening Bid $90
SA 18 – Local Sports Package
 Chicago White Sox - 4 upper reserved tickets
 Billy Pierce Autographed Plaque from 670 The Score
 Chicago Bears - autographed Brandon Marshall photo
 Bulls/Sox academy - certificate 30 mins use of batting cages
 One week summer camp with Roadrunners Soccer
Est Value: Priceless
Opening Bid $50
SA 19 – Something for Him
 DG Park District golf certificate
 Gene's Tire and Auto - 2 free oil changes and 2 free tire rotations
 DG barbershop GC
 Ditka’s $50 GC
Est Value: $200
Opening Bid $60
SA 29 – Tour Chicago
 Wendella boat cruises – Chicago 2 tickets 72
 Chicago pizza tour – Gift certificate for 2
 $25 Lou Malnati’s Gift Card
 Skydeck-4 tickets to the Willis Tower lookout
Est Value: $300
Opening Bid $90
SA 30 - Fashion
 Spend the afternoon with Mrs. Lyons and her sister Ginger!
 2 Free Tickets to the 27th Annual Helping Hand Center Fashion Show & Luncheon
 Saturday, April 18, 2015 @ 11:00 am-3:00 pm
 Crystal Sky Banquets, McCook IL
 Mrs. Lyons will personally pick up the winners and drive them home.
Est Value: Priceless! (Donated by Mrs. Lyons)
Opening Bid $30
SA 31 – Thrill Seeker
 2 passes to Vertical Endeavors
 2 passes to Menominee River Trip from Kosir’s
 2 passes to Peshtigo River Trip from Kosir’s
Est Value: $200
Opening Bid $60
SA 32 – Pamper Herself
 GC for cut and style from Carrie Grebel; includes salon goodies: Matrix Biolage
shampoo/conditioner, Wet Brush, OPI mini mani kit, Design fx nail appliques,
Essie base coat and top coat
 Jeans and a Cute Top Shop - Gift basket
 Egg Harbor $25 GC
Est Value: $150
Opening Bid $45
Donations keep rolling in! Keep your eye out for more
AWESOME packages!
Thank You to our local Donors!
Home Run Inn, Lou Malnati's, Chinn's, Stir Crazy, Tap House, Sushi House, Ballydoyle, Egg Harbor Café, Emmett’s Ale House, DQ, Country House ,
Jason's Deli, Ditka’s, Season's 52, Thai Café, Baked Apple, Soy Candles, Shelly Beavers, Trader Joes, Gracie Barra, Science and Industry, Field
Museum, Adler, Wendella Boat Tours, Chicago Pizza Tour, Skydeck, Chicago White Sox, 670 The Score, Chicago Bears, Bulls/Sox Academy, Seven
Bridges, SpringHill Suites Marriott Burr Ridge, Cooper's Hawk, Bear Paddle, Carrie Grebel, Hinsdale Nurseries, DuPage Children's Museum,
Aleksiunas Family, Pinstripes, Redbox, Lombard Roller Rink, Hollywood Cinema, Walter E Smithe, Sticks and Stones, Eye to Eye Interiors, Disney
World, Pinot's Palette, AMC, Paramount Theatre, Heritage Florist, Good Sam Wellness Center, Lost Mountain Adventure Golf, Raging Waves, Will
County Cougars, Sea Lion Aquatic Center, DG Park District, Gene's Tire and Auto, DG Barbershop, Tobias Music, Carrie Grebel, DG smile, Buke's,
Jeans and a Cute Top Shop, Style Studio, Berto's Deli, Uncle Bubs, Anderson's Book Store, Every Day's a Sundae, Teddy's Red Hots, Neat, Greg Horn,
Fugi Film, Frank Skupien, Coach Josh & Rick Porter, MB Croft, XRT, 12/12 Architects, Lynfred Winery, Lucky Strike Bowling, Maple Hill, Yoga by
Degrees, Adventure Realm, Chicago Funhouse, Roadrunner Soccer, Boyne Resort, Hunlen Landscape, Modern Music, Soy Enjoyable, Happy Dog
Barkery, Two Bostons, All M Dogs, Kelly’s Waggin’ Wheels, Vertical Endeavors, Kosir’s, Mrs. Lyons, Gallery’s Choice, Academy of Music and Art
Thank You Experience & All Things Whittier Donors!
Mr. Krugman, Julie Plepel, Jenna Carey, Eric Miller, Skyelar Edwards, Cheryl Lyons, Ericka Zagorski, Deb Krygeris, Ashley Pawlowski, Heather
Richards, Kyle Winter, Rosenberg Family, Brezina Family, Gianelli Family, Rausch Family, Kuelthau Family, Dobrez Family, Johnson Family, Eber
Family, Mielke Family, Cleveland Family, Potter Family, Donat Family, Toth Family, Hagen Family, McTigue Family, Williams family, Hardy Family,
Stein Family
We couldn’t do this without the generosity of our donors!
PRE-ORDER FORM
Tired of waiting in lines? Want more time for socializing?
Complete this form along with the attached credit card authorization form by Wednesday, March 18, and return in your
child’s folder in an envelope labeled “LP4P CC” and your packet will be ready and waiting for you at the Welcome Table
on Friday, March 20, 2015.
Name:__________________________________
Phone:_________________________________
E-Mail__________________________________
Item
# of tickets
$ amount
Tickets to Event
Cost: $25 each
Basket Raffle Tickets
Cost: $5/each,
5 for $20, 10 for $30
50/50 Raffle
Ticket Cost: $5/each,
5 for $20
Flashing Star Necklace - Heads/Tails
Cost: 1 for $10 (Purchase more than one to enter back into the game!)
TOTAL :
Method of Payment for Pre-order Packet (check one):
_______ Credit Card (complete form - attached) or ______ Check (payable to “Whittier PTA”)
PLEASE RETURN IN YOUR CHILD’S SCHOOL FOLDER IN AN ENVELOPE LABELED “LP4P CC” BY
Wednesday, MARCH 18, 2015.
Can’t make it this year? No worries, you can still participate in our fundraiser by purchasing
Basket Raffle Tickets and 50/50 tickets!***
***If you are buying Basket tickets and cannot attend the event, in the space below, please indicate which basket(s) you would
like to place your tickets, and we will take care of it for you!
Basket Name / Number
# of Tickets
CREDIT CARD AUTHORIZATION FORM
WE WILL KEEP TRACK OF YOUR SILENT AUCTION AND RAFFLE TICKET PURCHASES AND
YOU WILL BE BILLED AUTOMATICALLY.... NO HASSLES!
NAME: ___________________________________________
Cardholder Name: _________________________ Signature: ______________________________
Billing Address:
______________________________________________
______________________________________________
E-Mail Address:
______________________________________________ (for receipt***)
Credit Card Type:
_____ VISA
_____ MASTERCARD ____ DISCOVER
Credit Card Number:
________ - ________ - ________ - ________
Expiration Date:
________ / ________
Billing Zip Code: ________
Card Identification Number (last 3 digits located on the back of the credit card): _______
**** A DETAILED RECEIPT WILL BE SENT TO YOU VIA EMAIL ****