2003 Donor Form
Oscar Night® America

RETURN COMPLETED FORM TO:
Variety of Greater Kansas City
17 Anchor Drive Lake Tapawingo, MO 64015-9650
PHONE: (816) 220-2068 FAX: (816) 224-3734
Date Form Received: .

Date Item Received:

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Variety Office Records

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Please note that the event date is March 23, 2003.
Please make certificates valid for at least 1 year from date of event. (March 23, 2004)
Donor's Name AS IT WILL APPEAR IN PROGRAM: ___________________________
Address: _____________________________________________________________
City ________________ _________State ___________________ Zip_____________

Committee Member Name:_______________________ Phone:__________________
Title or Name of item:____________________________________________________

Description of item (details, highlights, # people, dates, services provided:

 

Restrictions (dates, expiration, exchange/transfer policy, inclusions, exclusions, etc.)

 
Estimated Retail Value: $_______________ (must have value to send tax receipt)
Yes No      Gift Certificate Enclosed?
Yes No      Variety Staff should make certificate?
Yes No      Use the contact Name and Phone listed above as the source to
redeem the certificate? (if No, list info below)

List any specific information and instructions about which you want the successful bidder to know as she or he redeems certificate:

 
PLEASE SELECT ONE OPTION BELOW TO INDICATE STATUS OF ITEM:
      The item is included with this Donor Form
      The Committee member soliciting the item has picked it up and will deliver it to the office by:______
      The item will be delivered to the office on ____________(date)
      The item will be mailed to office by (date)__________

      The item must be picked up by a committee member at (location/directions):_______________

-----------------------------------         On this day       Before    After

Date:________________________________