If you have questions or comments, please complete and submit this form. We will reply to you promptly. 

Thank you for your interest in helping these fine causes.

First Name*  
Last Name*  
* required fields

Address 2
Postal Code
Email Address*
Confirm Email Address
Phone Number
Let us know what we can do for you*  

NO PURCHASE, CONTRIBUTION, DONATION OR PAYMENT IS NECESSARY AND MAKING ONE WILL NOT INCREASE YOUR CHANCES OF WINNING. Donations are tax-deductible to the fullest extent of the law. 2013 Challenger Dream Giveaway starts on July 1, 2013 and ends May 31, 2014 at 11:59 p.m. EST. This giveaway is open to residents of the U.S. and Canada (except Quebec) and other countries and U.S. territories and possessions only where offered and permitted by law, age 18 and older. Void where prohibited. Odds of winning equal to one divided by the total number of tickets issued. This ad is for information purposes only, for entry and official rules including free entry method visit The Sponsor NBCH, a 501(c)3 organization located at 8800 New Beginning Dr., Gravette, AR 72736, is a licensee of the Dream Giveaway® brand. *$50,000 for TAXES applies to payment on behalf of winner for IRS withholding requirement, additional taxes may be owed. Chrysler Group LLC is not Sponsor of or affiliated with this promotion.