United Way NEMS

United Way of Northeast Mississippi Logo

Number of Tickets

Choose the Number of Tickets You Wish to Purchase

Ticketholder Information

Please review the terms and conditions for complete information regarding who is eligible to win. Ticket holder must be 21 or older. Ticket may only be in the name of one individual, or an organization if said organization is a nonprofit organization or church.

Please list the ticket holder's name and contact information below.

Prefix

First Name

Last Name

Mobile Number

Mailing Address

City

State

Zip

Birth Date

Did a volunteer or nonprofit organization ask you to purchase a ticket? Please enter their name here so they receive credit for your purchase!

By checking this box, I certify that I have read and agreed to the terms and conditions.

I certify that I am 21 or older at the time of my ticket purchase.

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Card Number

CVV

Include the $3.62 credit card processing fee so United Way receives 100% of your ticket purchase.

Donor hereby approves the payment of the donation and/or purchase to United Way of Northeast Mississippi and in the amount set forth herein.

You will receive a confirmation email with the details of your purchase. You will not receive a physical ticket. The email is your proof of purchase and entry in the contest. If you do not see the email in your inbox, please check your spam/junk folder. Thank you!

Number of Tickets

Ticketholder Information

Purchase Amount