Fortuna Optima Maxima Raffle!
Online Order Form

Welcome to online order form for the Fortuna Optima Maxima Raffle! Your payment will be handled on a secure connection via PayPal. In addition to the PayPal confirmation email, you will receive a list of your entry names from Ascanius within 24 hours of receipt. All fields below are required.

Questions? Concerns? Please contact registration@ascaniusyci.org.

**Raffle will be open until Wednesday, July 15, 2010. Make your donation before that date to reserve your entries!**
Organization Contact Information
Applicant's Name
Organization Name
School Affiliation
Email address

By submitting this online order, I certify that I represent a bona fide Latin or Classics Club, chapter of Eta Sigma Phi, or college/university Greek-life organization in Virginia, and that I am over 18 years of age.



This raffle is being conducted in accordance with Section 18.2-340.23 of the Code of Virginia.
Ascanius: The Youth Classics Institute is a 501(c)(3) nonprofit incorporated in the Commonwealth of Virginia.

©2010 Ascanius: The Youth Classics Institute
P.O. Box 188, Alton Bay, NH 03810 U.S.A. | email: info@ascaniusyci.org | phone: (866) 933-9466 | fax: (413) 502-3619