CMS RAFFLE DONATION CONFIRMATION FORM

Date of Event:  Wednesday, October 19, 2011

Thank you for donating today!

Your generosity will be graciously promoted on our website, in the event bulletin, and throughout the evening.

Please complete the form below. If you have any questions please email andriapeterson@hotmail.com or call the office at (541) 344-5366.

Your donation is tax deductible and will have a positive impact toward peaceful conflict resolution through mediation.

DONOR NAME: _______________________________________________________________________________

ADDRESS: ___________________________________________________________________________________

PHONE: ________________________________________    EMAIL: _______________________________

ITEM/S TO BE DONATED: ­______________________________________________________________________

Brief Description:

ESTIMATED VALUE OF ITEM: $_______________

Pick up/delivery?

____ Will Email on _____________________ to cara@communitymediationservices.com

____Will Mail on ______________________ to CMS PXP Raffle, 159 E 11^th Ave, Suite 100, Eugene OR  97401

____CMS will pick up - Earliest date item can be picked up: __________________________________

Location and contact person for picking up item:

Thank you for donating to our Peace by Piece event.