Raffle Donation Form

Contact Person:*

First Last

Phone:*

Email Address:*

Company Name:*

Website*

Address*

Street Address Address Line 2 City State ZIP Code

Donation

Items to be donated

Item	Value

All Raffle Donations will be mentioned in The Mesa Paper.

If you would like additional information about the event, or sponsorship opportunities, please email OMNI President Dr Teri Jory: terijory@gmail.com