2016 Cures Gala In-Kind Donation Form

  Please fill out completely.

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Name:

 

 

 

     

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City/State/ZIP:

 

    

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(Maximum response 255 chars, approx. 5 rows of text)

 

Please enclose any literature or materials that may be displayed with your item (i.e. menu, brochure, etc.)

 

To be listed in the event auction program, donated items and the completed donor form must be received no later than Friday, September 30, 2016.

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(as you would like it to appear in program book)

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If you chose "To Be Delivered", please send items to:

Delora Senft
Gateway for Cancer Research
1336 Basswood Road
Schaumburg, IL  60173
Telephone: 847.342.6976  Email:Delora.Senft@gatewaycr.org

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Mission Partners