vtcc

Virginia Treatment Center for Children Advisory Council
800 E. Leigh St. Suite 150
Richmond, Virginia 23219
TEL: 804-828-1123
FAX: 804-828-9879
www.virginiakids.net
Contact Us

 


USE THIS FORM IF YOU WISH TO DONATE ITEMS TO THE GALA

Virginia Treatment Center for Children
Third Annual Child Mental Health Award Gala
Willow Oaks Country Club
Friday, September 25, 2009 7 pm until 11 pm


*=Required field.

*Date
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*City:
*State:
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Fax Number:
*E-mail Address:
Items
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Value of Item(s)
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Would you like VTCC to pick up your donation? Yes No
Number to call to arrange pickup
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PLEASE PRINT A COPY OF THIS FORM FOR YOUR RECORDS BEFORE SUBMITTING.