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Win a 2016 Toyota and support the ODA’s charity and programs like the Tooth Taxi. $100 per ticket Only 1,000 tickets will be sold The car raffle drawing will be held in the Exhibit Hall at the Oregon Dental Conference Saturday, April 9, 2016 at approx.12:45 p.m. Purchase your ticket online now at SmileOnOregon.org or complete this form. Need not be present to win. Please return this form with payment, purchase online, or fax with credit card information to 503-218-2004. The Dental Foundation of Oregon • P.O. Box 2448 • Wilsonville, OR 97070 • 503-594-0880 Delivery date will be no later than April 25, 2016. Winner is subject to all applicable taxes and fees. Raffles are considered games of chance by the IRS and do not qualify as a tax deductible donation. E-Mail Name Address Zip Code State City No. of Tickets Alternate Phone Phone Total Amount Check No. Check Method of Payment: Cash Check Credit Card Credit Card # (Please check one: VISA M/C Discover AMEX) Signature Card Exp. Date

Win a 2016 Toyota and support the ODA’s charity and ... · Win a 2016 Toyota and support the ODA’s charity and programs like the Tooth Taxi. ... at the Oregon Dental Conference

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Win a 2016 Toyota and support the ODA’s charity and programs like the Tooth Taxi.

$100 per ticketOnly 1,000 tickets will be sold

The car raffle drawing will be held in the Exhibit Hallat the Oregon Dental Conference

Saturday, April 9, 2016 at approx.12:45 p.m.

Purchase your ticket online now at SmileOnOregon.orgor complete this form. Need not be present to win.

Please return this form with payment, purchase online, or fax with credit card information to 503-218-2004.The Dental Foundation of Oregon • P.O. Box 2448 • Wilsonville, OR 97070 • 503-594-0880

Delivery date will be no later than April 25, 2016. Winner is subject to all applicable taxes and fees.Raffles are considered games of chance by the IRS and do not qualify as a tax deductible donation.

E-MailName

Address

Zip CodeStateCity

No. of TicketsAlternate PhonePhone

Total AmountCheck No.Check Method of Payment: Cash Check Credit CardCredit Card #(Please check one: VISA M/C Discover AMEX)

SignatureCard Exp. Date