ChicaGO Safety & Sustainability Conference Raffle
January 21, 2016, Donald E. Stephens Convention Center, Rosemont, Illinois

50/50 Raffle supporting the EA Education Foundation Scholarship Program

Grand Prize of $10,000 awarded*

1 Ticket for $25 (or) 5 Tickets for $100

* Must be present to win the entire amount at the conference.  Drawing will take place at 5:30pm on
January 21, 2016 at the conference.  If winner is not present, half of the prize amount will be awarded.

Open to US Residents.  Only 1,000 tickets sold!  If less than 1,000 tickets are sold then the total prize amount will be adjusted accordingly to 50%.

I would like to purchase: One (1) ticket for $25 
Five (5) tickets for $100
 
Name
Company
Title
  Mailing Address
City, State, Zip
Phone
Email
 
Method of Payment
Credit Card Number
Exp. Date
Name on Card
  Credit card billing address is the same as company address above
* A 5% convenience fee will be added to all credit card payments.
If credit card billing address is different from company address, please specify below:
CC Billing Street Address
CC Billing City, State, ZIP
   

ChicaGO Safety & Sustainability Conference Raffle to Benefit
the Electric Association Education Foundation Scholarship Programs
:

 
 
I have read and accept and agree to the terms specified above  (read as a PDF PDF)  
 
 

By submitting this electronic form, I authorize the Electric Association to charge the appropriate amount to the above credit card for my tickets(s) for the ChicaGO Safety & Sustainability Conference Raffle (all prices are in US dollars).

or

Signature
(if submitted in printed form)


_____________________________________________

 
 

 


Electric Association
17W733 Butterfield Road, Suite B
Oakbrook Terrace, Illinois 60181

(630) 305-3050    phone
(630) 305-3056    fax


Email Carrie Spaeth or Amy Kasser for further information.

If you prefer not to register online, please print and sign this page, and fax it to the EA at: (630) 305-3056.