2013 Bill Phillips Memorial Golf Classic DONATION FORM For the purpose of assisting with the 16th Annual Bill Phillips Memorial Golf Classic, a fund raising event to benefit the American Heart Association on June 12th at Skyland Pines Golf Course, the undersigned donor hereby agrees to donate the item(s) described herein. Thank you for your support!
Description of Donation: (please be specific) _____________________________________________________________________________________ _____________________________________________________________________________________ Value: _________________
Expiration Date: ________________________
Restrictions: _________________________________________________________________________ Donated by: (as you would like it to appear in program) _____________________________________________________________________________________
Address: ____________________________________________________________________________ City: ______________________________ State: _______________ Zip Code: _________________ Phone: _________________________________ Best time to reach: ___________________________ Email: _______________________________ Please return to:
Fax: _______________________________________
American Heart Association
Tel: 330.478-8383
Catalog deadline
4682 Douglas Circle NW June 1, 2013 Canton, Ohio 44718 Attention: Molly Palmer Fax: 330.478.8681 email: molly.palmer@heart.org
________________________________ Donor Name (please print)
_______________________________ Donor Signature
o AHA representative will pick up item
_____________ Date
Requested pick-up date: ____________________
Federal Tax ID: 13-561-3797
Your donation may be tax deductible. Check with your tax advisor.