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Donation form race in these shoes 2012
- 1. DONATION FORM I, the undersigned, agree to donate the following item for use in The Cassie Hines Shoes Cancer Foundation’s 1st Annual Race in These Shoes on August 12, 2012. Please state exact description, including size, color, services provided, dates available, number of persons, days, weeks, nights, and restrictions, where applicable. ONLY ONE ITEM PER DONATION FORM. Signature: Brief Description of Item: Donor’s Estimated Value of Item: $ Exchangeable (circle one): Yes No I wish to make a cash donation in the Gift Certificate Enclosed (circle one): Yes No amount of $______________ (Make check payable to: The Cassie Hines Shoes Cancer Foundation) Expiration Date (if any): Any Restrictions? (circle one) Yes No If applicable, please list restrictions: Donor’s Name: Company Name: Address: City: State: Zip: Phone: Fax: E-‐mail: Recognize Donor Under (circle one): Pump Level Slip-‐On Level Loafer Level CHSCF Representative Name: Donor: Please return this form with your donation to the CHSCF Representative listed above or mail to: The Cassie Hines Shoes Cancer Foundation P.O. Box 345 Washington, MI 48094 Phone: 586.322.0991 Please keep a copy of this form for your records. The Cassie Hines Shoes Cancer Foundation is an IRS recognized 501(c)3 organization eligible to receive contributions. Your contribution may be tax deductible under IRS regulations. All Donors will receive an Acknowledgement Letter after the event.