Please mail the completed form along with your check/money order made out to Ford KTP Cares to P.O. Box 895, Pewee Valley, KY 40056.

Name: _______________________________________________________

Address:______________________________________________________

City, State and Zip Code: _______________________________________

Phone Number: ________________________________________________

E-Mail Address: _______________________________________________

Please send my tickets stubs: electronically _____ (free) or mailed _____ (stamped envelope provided)

Number of motorcycle raffle tickets ______ x $5 =   ________

Number of vehicle raffle tickets    _______  x $10 = ________

• Note: You may use one check / money order may be used for multiple ticket purchases (i.e motorcycle and vehicle raffle tickets).

How did you hear about the raffles? past purchase _____ web search _____ event flyer _______  friend _______ other (please explain) ______