donation & raffle entry form

Name: ______Phone #: ______

Email Address: ______

Pleasefill out the entire form andeither mail or email to the following address:
The Adrienne M. Kaiser Memorial Fund
P.O. Box 453
Ringwood, New Jersey07456

PRICING OPTION / # OF TICKETS / COST
1 / Super Ticket Package - $25 (a $60 Value) - Includes eight (8) Blue "Pick a Basket" Tickets PLUS two (2) Red "Grand Prize" Tickets
2 / Red "Grand Prize" Tickets - $10 each
3 / Blue "Pick a Basket" Tickets - $5 each
TOTAL

Red “Grand Prize” Tickets - This will be a standard raffle where all red tickets will be placed in the same “hat” and winners will be selected for the following prizes:

1 –Odyssey “White Steel” 2-Ball Putter with Callaway Golf Bag

2 –Taylor-Made CGB Max R7 Driver

3 – Sony Blu-Ray Disc Player

4 – Complete Set of LynxXMDGraphite Shaft Irons (3-PW)

5 – Toshiba 26 Inch LCD HDTV with Built In DVD Player

Blue “Pick-A-Basket” Tickets – This will be a raffle where each basket has its own “hat”. You will need to identify which basket raffle you want to enter and how many tickets you want submitted for each:

PRIZE # / BASKET DESCRIPTION* / # OF TICKETS
1 / “NY Yankees Fan” Basket
2 / “NY Giants Fan” Basket
3 / “NY Jets Fan” Basket
4 / “Baseball Lover’s” Basket
5 / “Music Lover’s” Basket
6 / “Golf Lover’s” Basket 1
7 / “Golf Lover’s” Basket 2
8 / “Golf Lover’s” Basket 3

*THE NEXT PAGE HAS DESCRIPTIONS OF SOME ITEMS FEATURED IN THE PRIZE BASKETS. THE LIST DOES NOT ALWAYS INCLUDE EVERYTHING IN THE BASKETS.

BASKET DESCRIPTIONS

1. “NY YANKEES FAN” BASKET

  • NY Yankees Mark Teixeira Jersey (Sz 52 – White)
  • NY Yankees Framed Picture
  • NY Yankees Glass/Tumbler

2. “NY GIANTS FAN” BASKET

  • NY Giants Eli Manning Jersey (Sz
  • “Giants Pride” Hardcover Commemorative Super Bowl 42 Book
  • Football Snack Trays
  • BBQ Utensils
  • NY Giants Glass/Tumbler

3. “NY JETS FAN” BASKET

  • NY Jets Mark Sanchez Jersey (Sz 52 – Green)
  • Football Snack Trays
  • BBQ Utensils
  • NY Jets Hat (Green)
  • NY Jets Glass/Tumbler

4. “BASEBALL LOVER’S” BASKET

  • 2 Tickets to Baseball Hall Of Fame (Cooperstown, NY)
  • Jimmy Rollins Baseball Bat

5. “MUSIC LOVER’S” BASKET

  • Various CD’s & Box Sets from Sony Music Entertainment as well as other Labels
  • Sony “Fashion Earbuds/Headphones”

6. “GOLF LOVER’S” BASKET 1

  • No Limits Hybrid 22 Degree Rough Cutter Golf Club
  • Adams Golf Shirt (XL/Yellow)
  • “Bag-Boy” Express Cooler Bag
  • Dunlap Black TI 18 Pack of Golf Balls
  • One Golf Glove
  • Golfer's Electric Coffee/Tea Mug Warmer
  • PGA Tour Golf Towel

7. “GOLF LOVER’S” BASKET 2

  • No Limits Hybrid 25 Degree Rough Cutter Golf Club
  • Adidas Climalite Golf Shirt (XL/Green)
  • Golf Pack Cooler
  • Dunlap Black TI 18 Pack of Golf Balls
  • Golf Glove
  • Golfer's Electric Coffee/Tea Mug Warmer
  • PGA Tour Golf Towel

8. “GOLF LOVER’S” BASKET 3

  • No Limits Hybrid 28 Degree Rough Cutter Golf Club
  • Golf Sweater (L)
  • Adams Golf Shirt (XL/Black)
  • Golfer's Electric Coffee/Tea Mug Warmer
  • Dunlap Black TI 18 Pack of Golf Balls
  • Golf Glove
  • PGA Tour Golf Towel