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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)



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 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!

Inkind Donation Form  

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

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