Company Name_____________________________________________________________
Contact Name_______________________________________________________________
How would you like your name to appear in the credits?_____________________________
Mailing Address______________________________________________________________
___________________________________________________________________________
City, State__________________________________________ Zip Code________________
Daytime Phone Number__________________ Alternative Phone Number_________________
Fax__________________E-Mail Address_________________________________
Web Site (if applicable)________________________________________________________
Amount being donated by check $______________________________________________
Product(s) being donated______________________________________________________
Products donated for the following: ____ guest room welcome baskets
____conference meals or snack breaks
____other (specify)____________________________
Monetary value of product(s) being donated_______________________________________
*If you are donating a product, when will you be bringing it to the Conference Committee?
________________________________________________________________________________________
* If you are donating an item that is to be included in the attendees welcoming packets, you
need to deliver it to the committe by February 1st for non-parishable items.
Check one: _____I will be shipping my product to the address below prior to March 1st.
_____I will be bringing or transporting my product myself.
Authorized Signature_________________________________________________________
Make checks payable to:
Celiac Disease Conference
PRODUCT CONTRIBUTIONS CASH CONTRIBUTIONS
Mail Contribution Form to: Mail Contribution Form to:
Denise Ramey Chapter 111 Celiac Sprue Association
c/o Raisin Rack PO Box 5280
4629 Cleveland Ave. NW Fairlawn, OH 44334
Canton, OH 44709
Faxed forms will not be accepted.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For Convention Committee Use Only
Date Sponsor Form was received_______________________________________________
Dollar amount or description of donation__________________________________________
_______________________________________________________________________________________
Check or products donated were received by______________________________________
Notes______________________________________________________________________
_______________________________________________________________________________________
