Oregon Club of Portland - Dedicated to Supporting University of Oregon Athletics

First Tech Credit Union Big Green Benefit DONATION Form
Please fill out the below information to register for the event. Someone will get back to you shortly.

CONTACT INFORMATION

Donor Name:

Address:

City, State, Zip:

Daytime Phone:

Alternate Phone:

E-mail Address:

DONATION DETAILS

I would like an event invitation

Donated Item Description for the Catalogue:
(please list any restrictions associated with the item.)

Unless otherwise specified, all donations are understood to be valid for one year from auction date.

Donation Stated Value: $

Check all that apply:

Merchandise

Gift Certificate

I will deliver

Please pick up

Please prepare a gift certificate for me

I am unable to contribute an item...

but would like to contribute $

to underwrite costs.

PAYMENT INFORMATION

Form of Payment:

Forwarding Check

Visa

Mastercard

Total Payment $

Account
Number:

Exp. Date:

Name as it appears on card:

SPONSORED BY

Monday, Sept. 11, 2009
5:30 pm
Tiger Woods Center
Nike World Campus


Ticket Price

Individual	$120
Table of 10	$1,200
Patron Table - includes patron host & guest gifts, Corporate signage	$2,750

If you would like to register for the event please click here: