LABMED 2002 Quilt Project Raffle

I'd like to enter the Raffle for the LABMED Heroes 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.
c/o Pat Kolb, Treasurer
213 Jeanne Lane
Chaparral, NM 88081

To place a credit card order, fill out the order form to process your order. Then call 972-208-2470 between the hours of 8AM - 8PM CST to supply your card number information.

LABMED now 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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