Wii™ Console RAFFLE
Part of the Proceeds Benefit the
Georgia Sheriff Association Youth Homes
In Memorial of a Fallen Hero, Officer David Gilstrap



Online Raffle Tickets

Drawing date December 19, 2007 at 9 AM.

Tickets also available at the Georgia Karate Academy, Inc.
16 N. Main Street, Watkinsville, GA 30677
706-769-3730

Raffle Tickets


Select the Number of Tickets (you must pick one):

Recipent's Name
Must be 18 or older or have permission from a parent or legal guardian to participate in this raffle.
First name

Last name

Please declare the legal status of the recipent:

Recipent's Age & Birthday
Please provide the age and date of birth of the
person receiving the raffle ticket(s).
Parent or Legal Guardians Name
NOTE: A minor must have a parent or legal guardian agree to the rules
and terms of the raffle listed below.
Skip this section if the recipent is 18 or older:
Parent or legal guardians first name

Parent or legal guardians last name

Your E-mail Address
What email address can we use to send you
your raffle ticket confirmation?

NOTE: WE DO NOT SELL OR GIVE OUT EMAIL ADDRESSES!
Your Mailing Address
City
State/Province
Zip/Postal Code
Telephone
(include area code)
Cell Phone
(include area code)
Credit Card
(you must pick one)
Payment INFO

Please select your credit card type

Card Number

Card Verification Number
What is this?

Card Expires On (example: 05/09)

Cardholder Name: First name

Last name
Billing Address
City
State/Province
Zip/Postal Code
Rules and Terms of the Raffle 1 Each ticket will cost $10 or $15 for two tickets. Winner of the Wii™ shall be in the name on the Raffle ticket stub and is not transferable or assignable.

2 Winner of the Raffle can pick-up the Wii™ console at the Georgia Karate Academy, 16 N. Main Street, Watkinsville, GA 30677 or request to have the Wii™ console mailed via UPS at the expense of the winner.

3 A person or entity may purchase a maximum of 2 tickets. No more than 1,000 tickets will be sold. The directors, officers and employees of the Georgia Karate Academy, Inc. are not eligible to win.

4 Individual purchasers of Raffle tickets must be 18 years of age or older or have permission from a parent or legal guardian to purchase a Raffle ticket.

5 Each numbered Raffle ticket stub will be placed in the Raffle ticket container. Online Raffle purchases will automatically be placed in the Raffle ticket container.

6 The Georgia Karate Academy, Inc. shall appoint a single individual who will be responsible for maintaining control and security of all of the Raffle ticket stubs. Such individual shall, by public certification under oath at the time of the drawing, certify that all Raffle tickets purchased have their stub in the contatiner of stubs where the winning Raffle ticket will be drawn.

7 The public drawing will be on December 19, 2008. Drawing Location: Georgia Karate Academy Inc. 16 N. Main Street, Watkinsville, GA 30677. Drawing Time: 9:00 a.m. You may attend the drawing. Please plan to arrive at approximately 8:45 a.m.

8 You need not be present to win.

9 Winner will be notified by phone, email, and certified mail with return receipt requested by December 26, 2008.

10 The Raffle Winner must claim prize within two (2) weeks of the Raffle drawing date or a new winner will be selected.

11 The Raffle winner is responsible for any applicable taxes.

12 This is not a tax deductible contribution.

13 The Raffle is subject to the Raffle terms and conditions in the State of Georgia and the Oconee County Raffle regulations. A Raffle license has been issused by the Sheriff's Department of Oconee County for this Raffle.

14 The Raffle is subject to all applicable federal, state, and local laws and regulations, and is void wherever prohibited or restricted by law.

15 If for any reason the raffle is canceled, Georgia Karate Academy, Inc. must reimburse each Raffle ticket purchaser within sixty (60) days of the Raffle cancellation date but may retain up to 7% of the ticket price for administrative costs.

16 Part of the proceeds of the Raffle are for the benefit of the Georgia Sheriff Association Youth Homes at 3000 Hwy 42, Stockbridge, GA 30281, in memorial for Officer David Gilstrap.

17 Check this website or telephone 706-769-3730 for additional information and notifications concerning the Raffle.

18 The undersigned agrees to allow, without compensation, the unrestricted use of any photographs, film, or video/DVD recorded material of the raffle winner to promote the outcome of the raffle.

You must acknowledge the rules and terms of the raffle.

How did you
hear about us?
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Comments
(optional)

Select amount to purchase from above BEFORE pressing the "Submit Form" button!

Note: All fields must be filled in order for your purchase to process correctly.

Return to Georgia Karate Academy, Inc.

Contact Information
Phone: 706-769-3730 • dgomez@georgiakarateacademy.com


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