Silent and Live Auction Donation Form

2021 Annual Gala

Donor Information

First Name

Last Name

Website/Link

Phone

Address Line 1

Address Line 2 (ex. apt)

City

State

Postal Code

References

Please share your connection to the Epilepsy Foundation Northern California:

If you were referred by a specific individual, please share their name below:

First Name

Last Name

Item Information

Name of Item Donated

Website/Link

Manufacturer

Model Number

Cost or Value

Complete Description of Item

If you are donating a service or gift certificate, please include: name of primary contact, instructions on how to redeem item, date of expiration.

Item Images

Logistics

Will you be dropping this item off or mailing it to the Epilepsy foundation?

Dropping offMailing Neither, this is not a physical item.

All donated items can be collected or mailed to the Epilepsy Foundation Northern California, 909 Marina Village Pkwy #239 Alameda, California 94501

All further questions can be directed to gala@epilepsynorcal.org and to Madeleine, Special Events Manager, at 510-469-0844

Thank you for your donation!

Contact Information