| Donation Request Form |
| Organization Name |
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| Contact Person |
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| Phone |
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| Fax |
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| Email |
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| Name of Event |
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| Event Date |
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| Type of Event |
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| How many people to you expect to attend? |
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| When is the donation needed? |
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| How will the donation be used? (door prize, raffle, etc.) |
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| How will Heinrichs Jewellery be promoted? |
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| Do you need a Heinrichs Jewellery logo?: |
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Yes No |
| Are any other jewellers participating? |
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Yes No |
| Has your organization received a donation from Heinrichs Jewellery previously? |
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Yes No |
| Comments |
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