Auction Item Donation Form
Thank you for helping us make a difference in the lives of individuals with CACNA1A-related disorders by donating an item for our Bid-For-A-Cure Online Auction. Donations are being accepted through Friday, October 10. The auction opens to SHOPPERS WORLDWIDE on Wednesday, October 29th and closes on Monday, November 3rd.
Donating Company
Written as you would like it to be listed.
Donor Contact Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Detailed Description of Item(s) being Donated
Description of Donated Item(s)
Estimated Value:
Please list any conditions or restrictions associated with the item(s)
Please upload any documents related to your auction item (company logo, photos, letters, vouchers, virtual gift certificates)
Upload a File
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of
Solicited By (name of CACNA1A representative who made the request):
My donated item(s) will be:
Mailed
Uploaded (see above)
Deadline is Friday, October 10th.
Please send items to CACNA1A Foundation, c/o Lisa Manaster, 31 Point Road, Norwalk, CT, 06854. For inquiries contact info@cacna1a.org.
The mission of the CACNA1A Foundation is to build a collaborative research network of patients, families, clinicians, and scientists that will work together to raise awareness and accelerate the understanding, diagnosis, and treatment of CACNA1A-related diseases.
To learn more about the CACNA1A Foundation visit www.cacna1a.org. Our Non-Profit Tax ID Number is 84-4985747.
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