ATL Event Donations Form


	LUO Atlanta Fundraising Event Monday, November 16th from 5:30 - 8:30 PM Eclipse di Luna - Park Place 4505 Ashford Dunwoody Road Atlanta, GA 30342 (678) 205-5862 Please print receipt and bring with you as entrance to the event


	Event Registration
	Today's Date Month Day Year
	Name* First Name Last Name
	Email*
	Address* City State Zip Code
	Phone
	Donation Amount ($10 per ticket) ex. $20 =2 tickets $


	# of tickets = Donation Amount 1 Ticket = $10.00 2 Tickets = $20.00 3 Tickets = $30.00 4 Tickets = $40.00 5 Tickets = $50.00 Please print receipt and bring with you as entrance to the event Each $10 donation allows you 1 ticket in the raffle. (3 chances to win throughout the night. Must be present to win.)

LUO Atlanta Fundraising Event