Student Club Gift Card Raffle
If your club is giving away gift cards as a club fundraiser, you need to
submit this form to be reimbursed for the gift cards purchased.
Return form to Coordinator of Student Life, Room L116, 815-802-8628
Club/Organization Name: _____________________________________________________
Club Member submitting form: _________________________________________________
Club Member's email: (KCC): __________________________________________________
Event Name: _______________________________________________________________
Event Date: ________________________________________________________________
Gift Cards to reimburse:
1. Gift Card Type/No.: ________________________________________________________
Gift Card Amount: _________________________________________________________
Winner’s Name (printed): ___________________________________________________
Winner’s Signature (handwritten): ____________________________________________
2. Gift Card Type/No.: ________________________________________________________
Gift Card Amount: _________________________________________________________
Winner’s Name (printed): ___________________________________________________
Winner’s Signature (handwritten): ___________________________________________
3. Gift Card Type/No.: ________________________________________________________
Gift Card Amount: _________________________________________________________
Winner’s Name (printed): ___________________________________________________
Winner’s Signature (handwritten): ____________________________________________
Questions? Contact Coordinator of Student Life, 815-802-8628 or studentlife@kcc.edu.
6/2016
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