Donation Form - The Lobster Extravaganza

Please submit this form by April 11, 2025 to be included in the auction program.

Auction Donation Agreement

Item Description(Required)

This will be your donation’s description in the program, please include as much information as possible.

Estimated Value of Donation (in USD)(Required)

All donations to Peterson Life with Cancer Auction are tax deductible as allowed by law. Federal Tax ID: 54-1071867

Expiration Date of Item (if applicable)

Please note the date of the event is May 3, 2025.

Are there any limitations, blackout dates or restrictions?

Yes

In detail, please describe limitations, blackout dates, or restrictions.

Pickup/Delivery Instructions of Auction Donation Items(Required)

All items must be received by April 11, 2025.

Donor delivery by April 11

Item delivered or requires only this form

Item requires pick-up

Please deliver auction items to: Inova Health System, Attn: Foundation/Brooke Williams, 8095 Innovation Park Drive, Fairfax, VA 22031

Display Material

Please note, the display area is limited. We encourage you to send brochures and business cards.

Yes

Please return this display material after the event

Please complete all information below so we may reach you if we have any questions regarding your donation.

Donor Name(s)(Required)

Please print clearly - this will be your “donated by” listing in the auction catalog.

Contact(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Name

This field is for validation purposes and should be left unchanged.