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‐‐‐ Ticket Stub & Payment RETURN Form ‐‐‐ To be used by NY Snowmobile Clubs only  

This form must be filled out COMPLETELY and ACCURATELY

and SUBMITTED with your PAYMENT and TICKET STUBS to assure that your CLUB DOLLAR SHARE is EXPEDITED!

PLEASE PRINT CLEARLY

Club Name ________________________________________________ NYSSA Club ID #_______________ Date _____________________________ Number of Tickets Enclosed________________ X $ 5.00 per Ticket = $ _______________Total Submitted Payment Method ( Indicate One ) Check ______ Check #__________ or Cash _______

~ Do not mail cash, cash may only be submitted at the NYSSA Forum ~

Club Contact Name ______________________________________Title ______________________________ Contact Phone Number Area Code ( _______ ) ________ - ____________ Contact Email Address (if possible) __________________________@ ______________________________

* * The deadline for submission is 12:00 Noon April 26, 2014 ** 

Make checks payable to the ONONDAGA COUNTY SNOWMOBILE ASSOCIATION

and send to

ONONDAGA COUNTY SNOWM0BILE ASSOCIATION P.O. BOX 392

SYRACUSE NY 13215

Received by _______________________________________________

ONONDAGA COUNTY SNOWMOBILE ASSOCIATION INC. In support of New York’s SNOWMOBILE TRAILS

NYS Identification Number: 31-215-850-08920 Raffle License # 15326 – Drawing held April 26, 2014