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2013 Bill Phillips Memorial Golf Classic DONATION FORM For the purpose of assisting with the 16th Annual Bill Phillips Memorial Golf Classic, a fund raising event to benefit the American Heart Association on June 12th at Skyland Pines Golf Course, the undersigned donor hereby agrees to donate the item(s) described herein. Thank you for your support!

Description of Donation: (please be specific) _____________________________________________________________________________________ _____________________________________________________________________________________ Value: _________________

Expiration Date: ________________________

Restrictions: _________________________________________________________________________ Donated by: (as you would like it to appear in program) _____________________________________________________________________________________

Address: ____________________________________________________________________________ City: ______________________________ State: _______________ Zip Code: _________________ Phone: _________________________________ Best time to reach: ___________________________ Email: _______________________________ Please return to:

Fax: _______________________________________

American Heart Association

Tel: 330.478-8383

Catalog deadline

4682 Douglas Circle NW June 1, 2013 Canton, Ohio 44718 Attention: Molly Palmer Fax: 330.478.8681 email:

________________________________ Donor Name (please print)

_______________________________ Donor Signature

o AHA representative will pick up item

_____________ Date

Requested pick-up date: ____________________

Federal Tax ID: 13-561-3797

Your donation may be tax deductible. Check with your tax advisor.

Golf Donation Form Go Red  
Golf Donation Form Go Red  

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