2016 Gala - Auction Donation

Fields marked * require an entry.

Thank you for supporting the 2016 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.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

Item or Certificate Delivery

Item/Certificate Delivery Method:

I will deliver the item/certificate to the Foundation before 3/30/2016

I would like the Foundation to provide a gift certificate for me

Please pick up my donation (Seattle/Eastside only)

Item Restrictions

Please list any restrictions (including expiration date):*

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:*

Important Dates:

All donation forms must be submitted by February 26, 2016.

Physical items and certificates need to be delivered to the Foundation Office by March 30, 2016.

EvergreenHealth Foundation

Mailing Address: 12040 NE 128th Street, MS#5, Kirkland, WA 98034

Physical Address: 12333 NE 130th Lane, Suite 300, Kirkland, WA 98034

Questions? Contact Meg Diemer at 425.899.1908 or MEDiemer@evergreenhealth.com