Fundraising

Casino Night Fundraiser

"*" indicates required fields

Number of Tickets Requested *

Price: $50.00

Payment Method*

Indicate your method of payment by checking one of the options below:

Credit card

Check

I'd like to help defer the cost of processing and credit card fees.

Yes - let me add a 3% credit card processing fee.

Additional 3% fee to help defer the cost of credit card processing fees:

Price: $0.00

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Please send check to: JCSVV P.O. Box 13, Sedona, AZ 86336. Designate “Casino Night” on check.

Billing Name*

First Last

Billing Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

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Thank you. You will receive an email confirmation upon submission.