WIN A TRIP FOR FOUR TO FABULOUS LAS VEGAS!

* $1500 Southwest Airlines voucher for four round trip tickets

* Two hotel rooms at Caesars Palace for three nights and four days

* Tickets are $50 each (limited to 400)

The Drawing will be held Monday, August 10, 2009 at 7:00 p.m. during the Leukemia Cup Golf Classic at Orchard Park Country Club. Ticket Holder need not be present to win.

Sponsored by: Acquest Development & Caesars Palace

Purchase tickets via credit card by filling out the order form below and the ticket(s) will be mailed to you.

*required fields

Las Vegas Raffle Ticket Order Form

First Name*
Last Name*
Company
Address*
City*
State*	Choose a State/Province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland And Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon
Zip/Postal Code*
Work Phone*
Cell/Home Phone
Email*
# of Raffle Tickets Ordered ($50 each)*
Credit Card (American Express, Discover, Mastercard, Visa accepted)
Credit Card #*
Expiration Date (mm/yy)*
Please check the box to give The Leukemia & Lymphoma Society permission to charge the raffle tickets purchased on the above credit card.*

THANK YOU!