IN ASSOCIATION WITH PHOENIX CHILDREN’S HOSPITAL,



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THIRD ANNUAL CASINO NIGHT & SILENT AUCTION

Saturday, October 4, 2008

Arizona Biltmore

All net proceeds will benefit Phoenix Children’s Hospital’s

Center for Cancer and Blood Disorders.

DONATION FORM

COMPANY/BUSINESS NAME: ____________________________________________________

ADDRESS: ____________________________________________________

CONTACT PERSON: ____________________________________________________

PHONE: ____________________________ FAX: ___________________________________

Please indicate below how you will contribute to our fundraiser. We appreciate your support and remind you that your donation is TAX DEDUCTIBLE. For your records, the tax ID number for Phoenix Children’s Hospital is 74-2421549 .

PLEASE RETURN or FAX THIS COMPLETED FORM WITH DONATION INFORMATION TO:

Gerri Richards, Committee Chair Irma Loebe, Committee Chair

Phone: (602) 569-7824 Fax: (602) 404-1593 Phone: (602) 569-6802 Fax: (480) 661-2803

19009 N. 35th Way Phoenix, AZ 85050 4542 East Libby Street Phoenix, AZ 85032

PRIZE DESCRIPTION: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

RESTRICTIONS, if any: __________________________________________________________ _____________________________________________________________________________

PRIZE VALUE: ____________________

Will you supply us with a gift certificate describing this prize? _____________

Do you need our auction committee to prepare a certificate? _____________

Do you need a donated item to be picked up? _____________

THANKS AGAIN FOR YOUR SUPPORT!

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