Gala Benefit Donation/Ad Form 2015
Event Date: Saturday, April 25, 2015
Donor Information
Name:
Phone:
Company:
Fax:
Address:
E-mail:
______
__
City/State/Zip:
Auction Item
Please provide a full description of the item as it should appear on the auction sheet. Include name or title
of the item, size, materials, expiration date or other limitations.
Description:
Estimated market
Value of item: _________
Item: __ Enclosed
Program Book Ad:
Cost
Deadline: March 31, 2015
Full-page
$150
Quarter-page $ 75
Half-page
$125
One Third-page
$ 100
Artwork is:
__ Business Card
Artwork is:
__ Enclosed
__ Will mail
__ Digital File
__ Pick up needed
__ Line Art
__ Will Mail by ______
Ad or item submitted to LCCIL by board member/volunteer/staff: ___________________
Please return this form with payment/item to: Lake County Center for Independent Living
377 N. Seymour Avenue
Mundelein, IL 60060
847-949-4440
All gifts are tax deductible to the extent provided by law.
Lake County Center for Independent Living is a registered 501(c) 3 not-for-profit
organization.