Rock the House Raffle Ticket Order Form
Every ticket is 3 gifts in 1!!
• a one-year Special Gold Membership to Fender Museum
• the Kids Rock Free program gets an immediate $50 “gift”
• you get a chance to win a Fieldstone home or one of 199 other valuable prizes.

RAFFLE TICKETS ARE $150 EACH
Only 10,000 tickets will be sold
Odds of winning a prize of $300 or more are 1 in 50 (at the 10,000 ticket level)

To order a raffle ticket, complete this form and mail or bring it to: Fender Museum, 365 N. Main St., Corona, CA 92880 or fax to 909-735-2576. For more information, please call 909-735-2440, then press 6 for the Special Events line.

Names (to appear on the ticket - any number):
__________________________________________________________________

__________________________________________________________________

Name to appear on the Gold Membership Card:
___________________________________________

Address:____________________________________

City: _____________________________________ State:______

ZIP:_________________

Home Phone: ( ......)___________ Work: ( ......)___________

Email Address: ____________________________

I am buying _____ Raffle Ticket(s) at $150 each. Total of this order is: $_____

Enclosed or attached is my check #___________ made payable to FMMA

Please charge my credit card:
MC___Visa___AmEx___ (check one): Card

#__________________________________Exp._________

By signing below, I certify that I am over 18 years of age and fully eligible to enter this raffle. Further, I certify that I have read and understand the rules, regulations and all disclaimers that pertain to this raffle and agree to accept them. I understand that modifications may be made to this raffle in its entirety. Lastly, by signing, I approve the processing of the credit card information provided above if that payment method has been selected. All sales are final. No payments will be refunded. Ticket(s) and membership card(s) will be mailed within approximately 10 days after your order is processed into our tracking system.

Signature: ___________________________________