2017 Evergreen Gala - Auction Item Donation

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Thank you for supporting the 2017 Evergreen Gala by donating an item for this year's auction! Please complete the information below.

If you have any questions, please contact Meg Diemer at mediemer@evergreenhealth.com or 425.899.1908. Thank you!

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*