GItem #___________ APItem #___________
2012 CATTLE BARON’S BALL
BENEFITING THE AMERICAN CANCER SOCIETY
PRIZE/AUCTION CONTRIBUTION FORM
(Please Print)
Name _____________________________Company __________________________________
Address ______________________________________________________________________
City _________________State ____Zip _____Phone ______________Fax ________________
E-mail _______________________________________________________________________
EVENT: Cattle Baron’s Ball Jr. Cattle Baron’s Ball (Kid’s Party) Cattle Baron’s Golf
DONATION TYPE: Gift Certificate Please Make a Gift Certificate Item is Attached
Item will be Delivered to ACS Office Item will be Delivered to the Darr Center on 8/17/12
Please Pick Up Item or Gift Certificate on _______________ (date if known)
Note: Perishable items will not be accepted. Please consider a gift certificate if your product is perishable.
Retail Value $____________
 I would not like my name/company to appear in publications
Description as you would like it to appear in promotional materials (not to exceed 40 words unless
it is livestock or a live auction item):_________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Restrictions (If any): ____________________________________________________________
_____________________________________________________________________________
_________________________________________
Signature of Donor
___________________
Title
__________
Date
_________________________________________
Signature of Cattle Baron’s Ball Committee Member
___________________
Phone No.
__________
Date
NOTE: Cattle Baron's Ball reserves the right to edit descriptions.
American Cancer Society Tax ID#: 74-1185665
Information must be received by May 31st to guarantee inclusion in promotional materials. Please
mail/fax/email or drop off any additional information, your logo and photographs to be used for
the website or for display at the event to the ACS Office.
Names of winners and all bidding information are confidential and will not be disclosed. The Cattle
Baron’s Ball does not give tickets in exchange for auction items.
Please sign, retain a copy as a receipt for your files, and return original to:
American Cancer Society 3322 S. Campbell, Suite G Springfield, MO 65807
Phone: 417-447-1483 Fax: 417-881-7955 Email: mary.valloni@cancer.org
Entered by___________