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FALS Draw Ticket Request Form

# of Tickets Requested ($1,000 per ticket)(*)
Please enter the number of tickets requested to purchase ($1,000 per ticket).

Group Name (if applicable)
Please enter your group name (if applicable).

Primary Contact First Name(*)
Please enter your first name.

Primary Contact Last Name(*)
Please enter your last name.

E-mail(*)
Invalid email address.

Phone(*)
Please enter your phone number.

Address(*)
Please enter your address.

City(*)
Please enter your city.

State(*)
Please enter your state.

Zip Code(*)
Please enter your zip code.

1st Ticket # Request (101-200)(*)
Please enter your first ticket number request (1-100).

2nd Ticket # Request (101-200)(*)
Please enter your second ticket number request (1-100).

3rd Ticket # Request (101-200)(*)
Please enter your third ticket number request (1-100).

(*)
Invalid Input

By submitting this request for a FALS Draw ticket, Fairbury Speedway officials will reach out to each request in a time stamped manner to officially secure a ticket. Please fill out the entire form above to allow for a response.

Payment due 30 days upon entry confirmation. Acceptable forms of payment include: cash, check, money order, and credit card. Credit card payments will have a 3% transaction fee added.

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