Hospice of Northwest Michigan
Formerly Charlevoix County Hospice, Inc.

P.O. Box 233 . Boyne City . Michigan . 49712 . 231-582-8800
Email us: info@hospicenwm.org

BOAT RAFFLE ORDER FORM

Fill in order form below, print, and send with your check (payable to Hospice of Northwest Michigan) to:
601 Bridge Street, East Jordan, MI 49727

Boat Raffle Tickets: $100 per ticket. Only 300 total tickets available.
Boat Raffle Tickets #Quantity Price Amount
Tickets # x $100.00 = $
Total: $
Your contact information:
Name:
Company/Organization (optional):
Address:
City, State, Zip:
Email Address:
Daytime Phone:
Evening Phone:

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