DOUTHAT STATE PARK
DISCOVERY CENTER BENEFIT AUCTION
2004 DONOR FORM


Donor Name:___________________________________________________________________________

Organization or Business:_______________________________________________________________

Mailing Address:_______________________________________________________________________

Phone:________________________________________________________________________________

Email Address:_________________________________________________________________________

Signature:_____________________________________________________________________________

Please include my donation in this year's auction.

I am unable to give this year , but please keep me on the mailing list.

I am unable to give this year and please remove me from the mailing list.

Item Description:____________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Approximate Item Value:_____________________

Please return this form and item to:
Denise Hayes, Auction Committee Chair
Douthat State Park * Route 1, Box 212 * Millboro, VA 24460
www.douthatspeed.org * douthatspeed@yahoo.com
(540) 458-8190

Auction Committee Use Only:

Item Number: __________ Silent Auction: __________ Live Auction: ___________