LABMED 2003 Quilt Project Raffle

I'd like to enter the Raffle for the LABMED 2003 Quilt!

Name:
Street Address:
City:
State:
Postal/Zip Code:
Country:
E-mail:
Phone Number:
Number of Tickets (@ $5.00US Each)
Amount:
Payment Method:

All you need do is:

- fill out the above electronic information form with your personal information.
- send the form electronically by pressing the 'submit' button below.

Then please mail a copy of this completed Quilt Raffle Tickets Order form along with your check or money order made payable to LABMED, Inc. to:

LABMED, Inc.
3941 Legacy Drive, Suite 204, #A115
Plano, Texas 75023

If you prefer, you may also provide payment via our secure server. Please follow the link at the bottom of the Quilt Ticket Confirmation page to complete the order process.

LABMED also accepts PayPal. Click on the button to make your payment, you will then be returned to this page to submit your order.

Then, accept our heartfelt thanks -- on behalf of everyone here at LABMED and your friends in Lab rescue -- for your support.

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