Timmy Global Health 10th Annual Event & Fundraiser
Friday, March 1, 2013
Conrad Indianapolis
DONATION CONFIRMATION FORM
Name of Business/Organization
Address
City
Contact Person
State
Zip Code
Phone
E-mail
Yes, we would like to support Timmy Global Health’s Silent or Live Auction!
Donated Item or Service
Actual or Estimated Value
*I confirm that the value of the listed item or service is at Fair Market Value.
Signature:
Check here [
] if your donation will be sent or delivered to:
Timmy Global Health
22 E. 22nd Street
Indianapolis, IN 46202
317-920-1822
Check here [ ] if you’d like to arrange a pick up of your donation. We are happy to schedule the
pick at your earliest convenience.
Please return this form to Timmy Global Health
 By Fax to 317-920-1821
 By Email to sarah@timmyglobalhealth.org
 By Mail to 22 E. 22 Street, Indianapolis, IN 46202.
Thank you for your generosity and your support of Timmy Global Health!