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Clarion Caring Angel Employee 50/50 Tickets

Payroll Information

Name:*

Employee Number:*

I am employed by:

Number of Tickets:*

Department:*

I authorize payroll deduction for the amount selected above:*

Yes

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Work Phone:

Email:*

Online ordering forms for basket and 50/50 tickets will be available until 5:00 pm on Friday, November 21.

Clarion Foundation staff will enter your tickets into the drawing. Stubs will be kept in the Foundation office. Your confirmation email will serve as your receipt.

Drawing will be held on Monday, November 24 and winners will be notified that afternoon. Pick-up will be coordinated at that time.

Please email Bridget.Thornton@independence.health with questions.

Clarion Caring Angel Employee 50/50 Tickets

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