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Mail to: (SOLD OUT)
ISMA North East Michigan Lodge #19 Raffle
C/O John M. Biolchini
239 W. Michigan Ave.
Rogers City, MI 49779


Name: ______________________________________________

Address: ____________________________________________

City: _______________________________________________

State/Province: _____________________________

Postal Code: _______________________________


Phone: (___)___________

Number of tickets: ___________ tickets are $20.00 (U.S.) each
Ticket sales are limited to 500 Tickets. Odds of winning 1:100

Amount Enclosed: ___________

Drawing February 6, 2004
License #C22524

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