Auction Item Donation

Fields marked * require an entry.

Thank you for supporting the 2015 Evergreen Gala by donating an item for this year's auction. Please complete the information below.

If you have any questions, please contact Tracie Ziegler at tmziegler@evergreenhealth.com or 425.899.1908.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Item or Certificate Delivery

Item/Certificate Delivery Method:*

Notes:

Item Restrictions

Please list any restrictions (including expiration date):*

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Please send me an invitation to the Gala!:

Yes

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*