Passover Follow Up Raffle - Chabad of Tallahassee and FSU

Student's Name*

First Name Last Name
Student's Birthday*

Month Day Year
Year in School*

Freshman Sophomore Junior Senior Grad Student
Student's Phone Number*

Area Code Phone Number
Student's Email Address*
Referred By:*
Parent's Name*

First Name Last Name
Parent's Phone Number*

Area Code Phone Number
Parent's Email Address
For additional raffle entries (one entry per contact), list any other family members that may be interested in supporting Chabad at FSU:
Full Name

First Name Last Name
Phone Number

Area Code Phone Number
Relationship to You
Full Name

First Name Last Name
Phone Number

Area Code Phone Number
Relationship to You
Should be Empty:

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