Leap Into HOPE Purchase Form

Saturday, February 29, 2020
7:00pm to 10:30pm

Metropolis Ballroom
6 S Vail Ave., Arlington Heights IL
Free Parking Available at the
Vail Avenue Garage
on the 1st, 4th and 5th Floors

High Stakes Poker
10 Seats Available $200

Split the Pot Raffle Tickets $25
will be sold on line until
Friday, February 28th @ 12pm

This donation form is on a secure server. If you prefer to purchase
your tickets or send your donation through the mail, please complete
the form, print it, and mail it to the address below.
Please make checks payable to JOURNEYS.

All fields marked with an asterisk (*) are required.

* Indicates required field

Name *

First

Last

Company *

Address *

City *

State *

Zip Code *

Phone *

Email *

I'd like to attend *

Additional Guest Names *

I'd like to sponsor the event *

Other Donation *

Seat at the High Stakes Poker Table *

$200 (only 10 seats available)

"Split The Pot" Raffle Tickets *

Total Amount *

Credit Card Number *

Select One *

Exp Date *

CVC Number *

Submit

JOURNEYS | The Road Home is a nonprofit 501(c)(3) agency and as such, your charitable donation is tax-deductible to the fullest extent allowed by law.

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