Donate To Auction

Fields marked * require an entry.

Thank you for your interest in donating to the St. Francis Medical Center Anniversary Gala. Please fill out the form below if you would like to donate an item to our auction.

Your item will appear on our auction website in either the silent auction, live auction or as a raffle. The placement of your donation will be up to the planning committee. Please mail or deliver the item or certificate to the address below before August 15th.

If you have any questions, please contact Cristin Drummond at Cristin_Drummond@bshsi.org or 804-370-7606. Thank you for your support.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Mobile Phone:*

Email:*