Type of Donation:
Check one of the following:
_____ Money Donation Amount: $_____________
_____ Food Donation
List Items: ____________________________________________________________
_____________________________________________________________________
_____ Products or Merchandise
List Items: ____________________________________________________________
_____________________________________________________________________
_____ Other
Explain: ______________________________________________________________
_____________________________________________________________________
Name: _______________________________________________________________
Business: _____________________________________________________________
Address: _____________________________________________________________
City: _________________________State: ___________________________________
Zip: __________________________Phone# _________________________________
Signature: _____________________________________________Date: ___________
*****************************************************************************
Donation: ____ Money
____ Food Donation
____ Product or Merchandise
____ Other
Number of items: __________
Received by: ___________________________Date: _____________________________
Make check payable to Lorri Seiger or Ancient Path Grove
C/O Cincy/NKY Pagan Pride Day
PO Box 296, Bethel OH 45106
Email: Krystal Wolf