2nd Annual Jackson Malia Memorial Golf Tournament

Raising Funds for Children with Special Needs

2009 Prize Raffle
Enter for your chance to win a six day trip for
four golfers to Prince Edward Island!

Grand Prize
4 rounds of golf on Prince Edward Island - Crowbush Cove, Dundarave,
Green Gables and Andersons Creek. 5 nights lodging at Rodd Brudenell River,
a Rodd Signature Resort, with daily breakfasts and full size rental van included.
Estimated value $5,000
Second Prize
42-inch flat screen Panasonic High Definition Plasma Television Estimated value $1,000
Third Prize
Apple iPod Touch Estimated value $230

Donation: $25 per ticket or 5 for $100

Drawing will take place October 6, 2009 at Hawk Pointe Golf Club.
Winner need not be present. No substitutions of prizes. No cash will be given in lieu of prize.
Blackout dates and restrictions apply. Participants must be over 18.
Receipt with official raffle number will be mailed to donors upon receipt of this form and payment.

Return this form with payment to:

Jackson Malia Fund Raffle • 759 Bloomfield Ave. Suite 304 • West Caldwell NJ 07006-6701
Name: __________________________________________________________________________
Address: _______________________________________________________________________
________________________________________________________________________________
Phone: (______) ____________________ Email: ________________________________________

Method of payment: ___ Check enclosed (made payable to Jackson Malia Fund) ___ Cash ___ Credit Card
Card Number: _______________________ Exp. Date: __________ Signature: ___________________________

Total raffle tickets _____ X $25= _____________ (Total amount enclosed)