Youth Scholarship Filly Raffle

Name:_____________________________________________

Address:___________________________________________

City:_______________________________________________

ST: ____________ Zip:________________________________

Phone:_____________________________________________

Email:______________________________________________

________________# of tickets @ $10.00 each

Amount enclosed: $__________________________________

We will mail you your tickets to the address given above.Please
send check by mail payable to the Youth Scholarship Fund to:

ARHA Youth Scholarship
P.O. Box 186
Nancy, KY 42544

Or fax credit card number and expiration date to:
606-636-6197

Thank-You for supporting our youth!