Please print this form, fill in appropriate information and mail to the address listed below.

Donation Form

Thank you for your support!

Monetary amount:    ($10)       ($25)       ($50)       (Other) $__________________

Or -- Item: __________________________________________________________
Donation suggestions include: food items, especially chocolates, restaurant certificates, hotel overnight stays, certificates for personal services, shopping gift certificates, etc. No item is too small -- it could make a great addition to a gift basket.

Description: (include number, size, color, dimensions, etc.)

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Restrictions: __________________________________________________________

Retail Value: __________________________________________________________

Contact Name: _______________________________________________________

Telephone: __________________________________________________________

Company Name: ______________________________________________________

(As it should appear in CHC program)

Address: _____________________________________________________________

City, State, Zip: ________________________________________________________

E-mail Address: _______________________________________________________

Donations can be sent or delivered to:

Ms. Dawn McGlone, 22 Lombard Circle, Lombard, IL 60148, 630-620-1457 or
Ms. Joan Wainovich, 1099 Sandpiper Drive, Chesterton, IN 46304, 219-926-5474

Please contact Ms. McGlone or Ms. Wainovich to arrange for a pick up.

Thank you so much for your generosity.

All donations will be recognized in the Anniversary Program Book, at the event, in the next newsletter, and on the website.

THANK YOU FOR HELPING US REACH OUR GOAL!