Test 123 Please enable JavaScript in your browser to complete this form.LayoutFirst Name *Last Name *LayoutPhone *Phone extension (optional)Email *EmailConfirm EmailLayoutAddress Line 1Address Line 2LayoutCityStateZipLayoutHow many raffle tickets would you like for yourself? They are $25 each, with a maximum of 10.0 - $ 0.001 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00How many other people would you like to buy raffle tickets for? (Maximum of 10 tickets per additional person)012345678910Gift Recipient #1LayoutGift Recipient #1: Full Name *Gift Recipient #1: Phone Number *Gift Recipient #1: How many raffle tickets?1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #2LayoutGift Recipient #2: Full Name *Gift Recipient #2: Phone Number *Gift Recipient #2: How many raffle tickets?1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #3LayoutGift Recipient #3: Full Name *Gift Recipient #3: Phone Number *Gift Recipient #3: How many raffle tickets? 1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #4LayoutGift Recipient #4: Full Name *Gift Recipient #4: Phone Number *Gift Recipient #4: How many raffle tickets?1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #5LayoutGift Recipient #5: Full Name *Gift Recipient #5: Phone Number *Gift Recipient #5: How many raffle tickets?1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #6LayoutGift Recipient #6: Full Name *Gift Recipient #6: Phone Number *Gift Recipient #6: How many raffle tickets?1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #7LayoutGift Recipient #7: Full Name *Gift Recipient #7: Phone Number *Gift Recipient #7: How many raffle tickets?1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #8LayoutGift Recipient #8: Full Name *Gift Recipient #8: Phone Number *Gift Recipient #8: How many raffle tickets? *1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #9LayoutGift Recipient #9: Full Name *Gift Recipient #9: Phone Number *Gift Recipient #9: How many raffle tickets? *1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Gift Recipient #10LayoutGift Recipient #10: Full Name *Gift Recipient #10: Phone Number *Gift Recipient #10: How many raffle tickets? *1 - $ 25.002 - $ 50.003 - $ 75.004 - $ 100.005 - $ 125.006 - $ 150.007 - $ 175.008 - $ 200.009 - $ 225.0010 - $ 250.00$25 each, with a maximum of 10 for this recipient.Please give us the best days and times to reach you and we will do our best to accommodate your schedule. Would you like us to send you a gift acknowledgment for your recipients?YesNoWould you like to receive updates from Dedication to Special Education? Yes, please subscribe my email to the following updates (select all that are of interest):Car Raffle UpdatesUpdates for Parents & FamiliesUpdates for Community MembersAnnouncements for EducatorsGolf Tournament UpdatesHow did you hear about the raffle? *I'm a family member of a child who receives Special Education services.I'm an educator.I, or a family member, work for MCOE (I'm not an educator).I got a postcard.I got an email from DSE (through MailChimp).DSE Board Member (curr or former Board Member and immediate families)Marin Sanitary (part of the MSS family/associates)Toyota Marin (curr or former employees, friends, family of Toyota Marin)United Markets advertisingVillage Corte Madera - I saw the car there!Web searchOtherTell us how you heard about the raffle *Donation Total$ 0.00We cannot take donations for raffle tickets online. After you complete the form above and select “Reserve Your Tickets” below, one of our Executive Committee members will call you (at a date/time you suggested) to take your donation by phone. Please ensure your phone number at the top of the form is correct, as that is the number we will contact for processing your donation, and the number we would call to notify the winner! Reserve Your Tickets
