Fields marked * require an entry.

Auction Item Donations

This year we will step back in time to Old Hollywood searching for... A World Without Type 1 Diabetes.. but we need your help!

Please consider donating an item for our auction on April 6, 2013.

Item Donation

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*

2013 Promise Ball Sponsors

Item Donation