Racing Stripes

NAME _______________________________________________________________________________________________
COMPANY ___________________________________________________________________________________________
LISTING ______________________________________________________________________________________________
(As you wish to be recognized in printed materials) r I wish for my gift to remain anonymous
Address ______________________________________________________________________________________________
City/State/Zip___________________________________________________________________________________________
Telephone (H) _____________________________________ (W) ________________________________________________
Email _________________________________________________________________________________________________
Number of Tickets/Packages ________
Ticket/Package Price $_______
Total Enclosed $_______
r Enclosed is my check for $________ payable to The Jeff Gordon Foundation.
r Please bill my Amex / MasterCard / Visa (circle one) in the amount of $_____________________________________
Name that appears on card_______________________________________________________________________________
Signature______________________________________________________________________________________________
Account #_________________________________________________________________Expires______________________
SPACE IS LIMITED. PLEASE RSVP BY JANUARY 2nd.
Contributions are fully deductible as provided by law.
For more information, contact Levy, Pazanti & Associates at 310.201.5033