Win a $40K Wheelchair Van for a PALS!

WIN A WHEELCHAIR VAN FOR A PALS! (Person diagnosed with ALS). 2019 GT BraunAbility Dodge Grand Caravan GT with automatic Wheelchair side ramp. Has only 25K miles! RETAIL VALUE MORE THAN $40K.

RAFFLE TICKETS ONLY $100. RECIPIENT MUST BE DIAGNOSED WITH ALS. Purchase tickets on behalf of a PALS or make donation.

Name of Purchaser *

First

Last

Email of Purchaser *

Phone number of Purchaser (numbers only no spaces) *

Please choose one option *

• If this ticket wins I would like the van to be donated to:
• I do not have a person with ALS in mind but would like to support this effort.

Name of Person with ALS who would recieve the Wheelchair Van (must be continental United States resident) *

First

Last

City (of PALS) *

State (of PALS) *ALAZARCACOCTDEDCFLGAIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Email of Person with ALS who would receive van *

Phone number of PALS (numbers only no spaces) *

Year of ALS Diagnosis *

Required *

• If I did not indicate a recipient, I certify this is a donation. Otherwise I certify that the named recipient has been diagnosed with ALS and plans to use the van and not sell it.

Submit

Drawing will take place October 1, 2022 on live video at the 2022 Healing ALS Conference. Minimum tickets sold: 400. New owner will be given $2000 towards gift tax or cost to pick up vehicle.