WCDDA SM Raffle Donation Form

WCDDA Annual Summer Meeting Raffle Donation Form
The WCDDA Fund supports local dental health education, access-to-care initiatives, careers in dentistry, and disaster relief throughout the West Coast District. To date, the Fund has contributed over $49,000 in scholarships and grants to support a variety of organizations and programs.

All contributions are directed to the WCDDA Fund, with the exception of 5% allocated to the Florida Dental Health Foundation to offset administrative costs.
Contact Information
Today's Date

MonthDayYear
Date
Company or Donor Name
Company or Donor's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Contact Name

First NameLast Name
Contact Email
example@example.com
Raffle Information
1. Please describe the raffle item that you will be donating:
2. What is the estimated value of raffle item?
Will you be shipping the donation to the central office, or bringing it to the hotel?
For questions, please contact the WCDDA Central Office at 813.654.2500.
Should be Empty:

WCDDA Annual Summer Meeting Raffle Donation Form