Gala Auction Donation Form

Fields marked * require an entry.

Thank you for your interest in donating an item for our 2012 Gala! These donations help us raise critically needed dollars for research to cure, treat, and prevent type 1 diabetes and its complications.

All donations are tax-deductible and will be acknowledged in the Gala Ad Book.

If you have any questions, please contact Robin Berger, Development Director, at rberger@jdrf.org or 856-429-1101.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Restrictions and/or Expiration:

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:

Email:*

Thank You To Our 2012 Partners and Sponsors