GRC Raffle Donation Form

GRC Raffle Donation Form

Please complete this form by Wednesday, October 15
Name*

First NameLast Name
Email*
example@example.com
Hospital/Organization Name*
Item I will donate:*
Description of Item donated (1-2 sentences):*
Value of donated item (must be $75 or more)*
Is this a personal donation or donation made by your hospital or organization?*
Will you bring the item to Fall Conference on October 22 or mail it by October 15?*

I will bring it along to Fall Conference with meI will ship it to arrive by 10/15; please send me the mailing addressI will need someone to pick it up, please contact me to make arrangements
Should be Empty: