(To print this form, click the "Print" button on your Web Browser)


Mail to:
United Way of St. Clair County
1723 Military St.
Port Huron, MI 48060

 The drawing will be held April 26, 2012 at 5:30 p.m. at the Thomas Edison Inn.


Name: ______________________________________________

Address: ____________________________________________

City: _______________________________________________

State/Province: _____________________________

Postal Code: _______________________________

Country:______________

Phone: (___)___________

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

Amount Enclosed: ___________

State of Michigan License # R13463


Return to Great Lakes & Seaway Shipping    www.BoatNerd.Com