Virginia Treatment Center for Children

Butterfly Ball - Third Annual Child Mental Health Gala

Willow Oaks Country Club

Friday, September 25, 2009 7 p.m. until 11 p.m.

 

BENEFIT AUCTION DONATION FORM

 

Name ____________________________________   Phone ________________________

 

Company/Organization____________________________________________________

 

Address:__________________________________________________________________

 

City/State/Zip _____________________________________________________________

 

E-mail address: ___________________________________________________________

 

Item(s)  __________________________________________________________________

 

Description/Limitations ___________________________________________________

 

___________________________________________________________________________

 

Value of Item(s)  __________________________________________________________

 

How would you like donation recognized in the program:

 

___________________________________________________________________________

 

Would you like VTCC to pick up your donation picked up YES_____   NO_____

 

Phone number to call to arrange pickup_____________________________________

 

Please contact Delores Richards-Madikiza at 804.828.1123 or drichards-madikiza@mcvh-vcu.edu

 

Save This Portion for Your Records

 

Donated to VTCC Butterfly Ball

Friday, September 25, 2009

 

Name: __________________________________Date: ______________

 

Item donated: ____________________________________ Value: _____

Item donated: ____________________________________ Value:  _____

 

Advisory Council of the Virginia Treatment Center for Children
800 E. Leigh Street, Suite 150   Richmond, VA 23219 www.virginiakids.net

Tax ID # 52-1586450

BACK TO DONATION PAGE