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5th Annual Dr. Jack Logan Memorial

Golf Tournament Saturday, April 20, 2013 ď‚ž Tannenbaum Golf Course ď‚ž Greers Ferry Lake Benefiting Conway Interfaith Clinic Inkind Donation Form Donor Name: Address: Phone:

Contact Person: City, State, Zip: Fax:

Donation Information Donated Item(s)/Service(s)

Email:

Qty

Value $ $ $ $ $ $ $ $ $ $

Purpose of Donation

To Secure Donor Recognition

Please send completed form(s) and entry/sponsorship fee(s) to Conway Interfaith Clinic, 830 N. Creek Dr., Conway, AR 72032. To ensure inclusion in printed materials, please submit names/logos (text or EPS files) by March 15, 2013 to kittie.aaron@conwayinterfaithclinic.org Goodie bag and raffle items may be delivered to the clinic, or please call (501) 932-0559 to make arrangements for items to be picked up by March 15, 2013

Benefiting Conway Interfaith Clinic

The mission of the Conway Interfaith Clinic, a 501(c)(3) organization, is to provide medical care for the working uninsured and dental care for children with ARKids or Medicaid.

Thank you for supporting Conway Interfaith Clinic! http://conwayinterfaithclinic.org

Inkind Donation Form  

Inkind donation form for the Conway Interfaith Clinic's 5th annual Dr. Jack Logan Memorial Golf Tournament.

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