B Stigma-Free Southern CT Coalition Sponsorship Form

2014 Essay Contest Sponsors Confirmation

 

DESCRIPTION OF DONATION: _____________________________________________

________________________________________________________________________

EXPIRATION DATE: _______________             VALUE: ______________

CIRCLE ONE:       CASH               GIFT CERTIFICATE          GIFT BASKET

DONOR INFORMATION

COMPANY NAME_________________________________________________________

ADDRESS______________________________________________________________

CITY/STATE/ZIP_________________________________________________________

CONTACT PERSON______________________________________________________

EMAIL ________________________________________________________________

SIGNATURE____________________________________________________________

PHONE______________________________________

DATE________________________________

NAMI Fairfield is recognized by the Internal Revenue Service as a not-for-profit corporation under code section 501(c)3 and all contributions are tax deductible to the fullest extent allowed by law.

DONATION DEADLINE – MAY 20, 2014     FED TAX ID 06-1608813

Please make checks payable to NAMI Fairfield and mail form and donation to:
B Stigma-Free, 2490 Black Rock Turnpike #294, Fairfield, CT 06824. If donation is a gift basket please call 203.255.7703 to arrange for pick-up.