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On Line Raffle Donation

We would like to be a part of the OC Look Party by donating an item for the raffle.
We understand that we will be recognized at the event and will receive an acknowledgement letter for our donation. All dollars raised from the raffle go to support diabetes research.

Item Donation

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:*

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Item Donation