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Raffle Ticket Order Form

First name*

Last name*

Email*

Phone

Raffle Ticket Purchase

Single Raffle Ticket

Single Raffle Ticket$10

Raffle Ticket Bundle (20 tickets)

Raffle Ticket Bundle (20 tickets)$100

Raffle tickets purchased online will be prepared and ready for pick up at the post-golf reception located at the Elk's Lodge. Raffle items will be displayed and tickets are to be placed in the respective box for entry.

3310 S Cornhusker Drive

York, NE 68467

(402)205-1421

info@countrysidepd.com

Monday | 7:30 - 4:00
Tuesday | 7:30 - 4:00
Wednesday | 7:30 - 4:00
Thursday | 7:30 - 4:00
Friday | 7:30 - 12:00

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© 2023 by Countryside Pediatric Dentistry

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