Page 15 - Peaks Brochure
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LAST YEAR'S WINNER:
ISAAC & FRAIDY GOLDBRENNER
FLATBUSH, NY
ORDER FORM
NAME _______________________________________________ ADDRESS ____________________________________________ CITY / STATE / ZIP _____________________________________ PHONE ______________________________________________ EMAIL _______________________________________________ DONATION AMOUNT:
$36 — 1 TICKET
(Early bird 2 tickets)
$50 — 3 TICKETS
(Early bird 6 tickets)
OTHER AMOUNT: $ ____________________________________
VISA MASTERCARD DISCOVER AMEX
CC# _________________________________________________ EXP. ___________ / ___________ CVV ____________________
CHECK ENCLOSED PAYABLE TO KIMPATORIN AID
ENTER BY
$100 — 10 TICKETS
(Early bird 20 tickets)
$165 — 25 TICKETS
(Early bird 50 tickets)
MAIL: PHONE: FAX: EMAIL: ONLINE:
1324 50TH STREET, BROOKLYN, NEW YORK 11219 718.483.8410
718.483.8411
DONATE@KIMPATORINAID.ORG KIMPATORINAID.ORG/SWISS
No purchase necessary. For free submission please mail us a postcard with your contact info. Must be 18 years or older. Winner responsible for any taxes. By participating in this ra e, participants agree that they release Kimpatorin Aid from any liability in connection with any human or technical errors that may occur.
