|
Name |
|
|
Address |
|
|
City |
|
|
State |
|
|
ZIP Code |
|
|
Telephone (home) |
|
|
Telephone (business) |
|
|
Fax |
|
|
|
|
I (we) plan to make this contribution in the form of:
Item
Gift Basket
Service
Gift Certificate (please list restrictions below)
|
Description of Donation:
|
Estimated Value of Donation $__________________
Delivery of Donation:
________Bring donation to the conference
________Send donation to the IBBIA office (Please send donations at least one week prior to conference.)
|
Expiration Date: _______________
Black-out Dates: _______________
Restrictions:
|