Full NameFirst NameLast NameE-mailAdditional Family AttendingT-Shirt SizeSmallMediumLargeExtra LargeThis event is free, but please consider purchasing raffle tickets for some great prizes, to benefit the Friendship Circle of Dallas.Thank you to our raffle sponsors;Chooze Shoes, Enlighten MD, andThe Surplus Company.If you would like to make a donation to help Friendship Circle please click herePlease select your raffle tickets belowChooze Reversible Back PackSelect One$5 - 1$10 - 2$15 - 3$20 - 4$25 - 5$30 - 6$5 for 1 entry$50 Dick's Sporting Goods GiftcardSelect One$8 - 1$16 - 2$24 - 3$32 - 4$8 for 1 entry$50 iTunes GiftcardSelect One$8 - 1$16 - 2$24 - 3$32 - 4$8 for 1 entry2 tickets to 6 FlagsSelect One$10 - 1$20 - 2$30 - 3$40 - 4$50 - 5$60 - 6$70 - 7$10 for to win 2 one day passes$80 Lululemon GiftcardSelect One$10 - 1$20 - 2$30 - 3$40 - 4$50 - 5$60 - 6$10 for 1 entryEnlighten - One photo facial or $250 to any treatment of your choice *For new patients onlySelect One$10 - 1$20 - 2$30 - 3$40 - 4$50 - 5$60 - 6$70 - 7$80 - 8$90 - 9$100 - 10$10 for 1 entryEnter Each Raffle once$180 to be entered once$360 to be entered twice$180 to be entered into each raffleTotal$0.00PaymentCredit CardVisaMasterCardAmerican ExpressDiscoverCredit Card TypeCredit Card NumberSecurity CodeName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2017201820192020202120222023202420252026Expiration YearBilling AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandTurkish Republic of Northern CyprusNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTransnistria PridnestrovieTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryQuestions and/or Comments:SubmitShould be Empty: This page uses TLS encryption to keep your data secure.