YES! I WANT TO WIN A WINE CELLAR
Do it now! Your order form and payment must reach us prior to May 11, 2009.
Click here to print this form.
Send your payment and the completed form to:
Cincinnati Children's Hospital Medical Center
Win A Wine Cellar X
Division of Rheumatology MLC 4010
3333 Burnet Avenue
Cincinnati, Ohio 45229
The tickets cost $40 each or three for $100.
We will mail you ticket stubs and a thank you note showing you participated in the drawing. Your cancelled check will provide an additional receipt.
| Name | _________________________________________ |
| Address | _________________________________________ |
| City | _________________________________________ |
| State | ___________________________ Zip__________ |
| Phone | _________________________________________ |
| _________________________________________ | |
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Please charge my credit card $ _______________
__Visa __MasterCard __American Express __Discover |
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| Account number | ________________________ Expiration_______ |
| Name on card | _________________________________________ |
| Signature | _________________________________________ |
Questions or comments? Contact us.
