Order Form for 'Casino Royale' tickets and/or spaces on our 'Rotary Wheel of Hope'

Please complete the order form below, then hit the 'SUBMIT' button. You will then be offered the option to pay for this order by mailing a check, using a major credt card or PayPal. A Rotarian will contact you shortly to confirm your order. If you are experiencing difficulty with this form, please call 941-448-5500.
Full name:	* required
Mailing address:	* required
City/State/Zip:	* required
Email address:	* required
Telephone number:	* required
Number of Casino Royale tickets:	* required
Please enter the names of each ticket holder included in this order.
Ticket holder#1:	* required
Ticket holder#2:
Ticket holder#3:
Ticket holder#4:
Please enter below the number of $50. spaces on our 'Rotary Wheel of Hope' game included in this order. Attendance not required to win the 7-day stay at a vacation home in the Florida Keys.
Number of 'Wheel of Hope' spaces:
Check here if you are mailing payment.