Mail Below Form with payment
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Raffle Ticket Issued to : ______________________________________________________
(Use your PP Screen Name or include a real name and phone number for notification)

Size  (Circle One):    XXL      XL      L       M     S


[ ] I want to pick up my shirt at 15840 SE 170th Street - Renton, WA 98058
   OR
[ ] I want my shirt mailed back to

Return Address:  
	_____________________

	_____________________

	_____________________

	_____________________


Note to Matt : ____________________________________

___________________________________________________


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Mail cash or check (Checks Payable to James Amandus) to:

James Amandus
Attn: Shirt Raffle
15840 SE 170th Street
Renton, WA 98058