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Please make checks payable to: ISMA Port Huron Lodge 2
Mail Check, ticket order form to:

ISMA Port Huron Lodge 2
P.O. Box 611634
Dept. GLSS
Port Huron, MI 48061-1634

Drawing will take place Saturday March 4, 2017 at 10:00 pm. Hilton Doubletree Hotel, Port Huron, Mich.

Name: ______________________________________________

Address: ____________________________________________

City: _______________________________________________

State/Province: _____________________________

Postal Code: _______________________________


Phone: (___)___________

Number of tickets: ___________ tickets are $10.00 (U.S.) each

Amount Enclosed: ___________

State of Michigan License # R-3567

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