Caregiver Dinner Sponsor & Auction Donation Form 2016
Senior Action Network of Thurston Mason Lewis County
Event Date: November 3, 2016
Event Location: South Sound Manor, 455 North St. SE, Tumwater, 98512
Co-Chair: Cyndi Lounsbury 360.951.9058, or Stacy Johnson 360.943.9900
Thank you for supporting the Senior Action Network (SAN) mission for enhancing lives of our elder citizens! Please fill out this form
completely and return it to a SAN member representative or mail to the address below. For tax purposes, retain a copy of this page
for your records. Dinner theme - Caregivers: We Celebrate YOU!
Ways to Participate: Silent Auction and Caregiver Gift Card Sponsorship
Choose ONE or BOTH opportunities to Celebrate the Caregiver and support the Senior Action Network.
Important: To be included in event media, you must return this completed form by October 1, 2016
Company:
__________________________________________________________________________________
Contact Person: __________________________________________________________________________________
Address:
__________________________________________________________________________________
City:
_______________________________________________ State: ____________ Zip: _____________
Primary Phone: ______________________________________ Alternate: __________________________________
Email address: _________________________________________________________________________________
Fax Number:
______________________________________ Preferred contact:  Phone
 E-mail
 Fax
SAN Caregiver Event Donation. Proceeds from auction support SAN programs
Please complete this form for each item donation by October 1, 2016.
Description
Item Name
Stated Value: $
Choose one for your Donated item:
 I have item included /attached.
 I will mail item to arrive by October 1, 2016
 I will deliver to event by 3:00 p.m. on
Thursday, November 3, 2016
 I need an item pick-up. Please call me to arrange.
 Caregiver Gift Card Sponsor: Quantity _________ @ $50.00 each Total Sponsorship Amount: $__________
Check to be mailed to SAN to arrive by October 1, 2016
Senior Action Network is a 501(c)(3) not for profit organization. Tax I.D. 911987144
Senior Action Network of Thurston Mason Lewis County • P.O Box 12212, Olympia, WA 98508-2212
www.Senior-Action.net • 1-888-411-8823 • e-mail: [email protected]