1st Annual Poker Night and Silent Auction

Friday, March 26, 2010 -- 7:00 pm

DONATION FORM

Thank You For Your Silent Auction Donation!

Instructions: The form below is for you to provide us with information about who you are, what you are donating and its value, so that we can send you a donation letter for your taxes. After completing the required information, click on the 'Send form' button. At that point, you will be able to print a copy of the donation information you sent for your records.

Description of item(s):
Value(s):
Donor name:
Donor company:
Donor address:
City:
State:
Zipcode:
Phone:
E-mail:
Solicited by Women's Clinic representative:

We ask that all donations be in our office by Friday, March 19, 2010. Thank you.

Please send your donated item(s) to:

Scott Warnke
Women's Clinic & Family Counseling Center
9911 West Pico Blvd., Suite 500
Los Angeles, CA 90035
Telephone: (310) 203-8899 extension 108
Fax: (310) 203-8555

Women's Clinic has been determined by the Internal Revenue Service to be tax-exempt under Section 501(c)(3) of the United States Internal Revenue Code. All contributions are tax deductible to the fullest extent allowed by law.

Tax Donation Letters Will be Sent to the Donor Name and Address Listed Above Unless Otherwise Requested.

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