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34^th ANNUAL AUCTION

Donate Item

Donation Amount:

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes (Include limitations or restrictions, if any. Catalog description will be based upon this information):

I am a(n):*

Individual Donor
Business Donor

I would like to remain anonymous:*

YesNo

Is it a tangible Item?*

YesNo

Gift Certificate

Gift Certificate provided?

YesNo

Display Item

Display item provided?

YesNo

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*