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					PRI N T O UT T HI S FO RM. IF YO U N EE D M ORE S HEE T S M A KE C OPI ES B EF ORE YO U FILL I T O UT.

  1. Select the basket(s) for which you would like to enter coupons.
  2. Fill out the coupons completing all the information. Sorry, any coupon not completed will be voided.
  3. Mail the coupons along with one check/money order for the total amount payable to BROADWAY
     CARES/EQUITY FIGHTS AIDS to: Lilian Barbuti, 23-39 33 Street, Astoria, NY 11105, USA.
                     ***DEADLINE FOR SUBMITTING COUPONS IS THURSDAY, SEPTEMBER 19, 2002***


                                                                  C
  Broadway Cares Equity Fights Aids Fundraiser 2002               U     Broadway Cares Equity Fights Aids Fundraiser 2002
                                                                  T
  Raffle Basket #____________________________________________         Raffle Basket #_________________________________________________
                                                                  C
  Membership # (if applicable) ________________________________   O   Membership # (if applicable) _____________________________________
                                                                  U
  Name:____________________________________________________       P   Name:_________________________________________________________
                                                                  O
  Address:__________________________________________________      N   Address:_______________________________________________________
                                                                  S
  __________________________________________________________          _______________________________________________________________
                                                                  O
  Telephone # _______________________________________________     U   Telephone # ____________________________________________________
                                                                  T
  2 coupons for $5.00                  6 coupons for $10.00           2 coupons for $5.00                    6 coupons for $10.00
                            MAKE CHECK/MONEY ORDER PAYABLE TO BROADWAY CARES/EQUITY FIGHTS AIDS

                                                                  C
  Broadway Cares Equity Fights Aids Fundraiser 2002               U     Broadway Cares Equity Fights Aids Fundraiser 2002
                                                                  T
  Raffle Basket #____________________________________________         Raffle Basket #_________________________________________________
                                                                  C
  Membership # (if applicable) ________________________________   O   Membership # (if applicable) _____________________________________
                                                                  U
  Name:____________________________________________________       P
                                                                  O   Name:_________________________________________________________
  Address:__________________________________________________      N
                                                                  S   Address:_______________________________________________________
  __________________________________________________________
                                                                  O   _______________________________________________________________
  Telephone # _______________________________________________     U
                                                                  T   Telephone # ____________________________________________________

  2 coupons for $5.00                   6 coupons for $10.00          2 coupons for $5.00                   6 coupons for $10.00
                            MAKE CHECK/MONEY ORDER PAYABLE TO BROADWAY CARES/EQUITY FIGHTS AIDS

                                                                  C
  Broadway Cares Equity Fights Aids Fundraiser 2002               U     Broadway Cares Equity Fights Aids Fundraiser 2002
                                                                  T
  Raffle Basket #____________________________________________         Raffle Basket #_________________________________________________
                                                                  C
  Membership # (if applicable_________________________________    O   Membership # (if applicable ______________________________________
                                                                  U
  Name:____________________________________________________       P   Name:_________________________________________________________
                                                                  O
  Address:__________________________________________________      N   Address:________________________________________________________
                                                                  S
  __________________________________________________________          _______________________________________________________________
                                                                  O
  Telephone # _______________________________________________     U   Telephone # _____________________________________________________
                                                                  T
  2 coupons for $5.00                   6 coupons for $10.00          2 coupons for $5.00                  6 coupons for $10.000

ALL WINNERS WILL BE CONTACTED. A LIST OF WINNERS WILL BE PUBLISHED ON THE M.C.I.F.A. WEBSITE. IF YOU WISH A WRITTEN LIST OF
                         WINNERS PLEASE INCLUDE A S.A.S.E. MARKED “WINNERS” WITH YOUR ENTRY.

				
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posted:7/14/2011
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