Please fill out the form below, or click to download this pdf file.

*Please note, all fields are required.

Forms need to be submitted by Oct 1, 2017 to ensure information is printed in the program.
Thank you for supporting the Crystal Gala Foundation.
Event Date: October 21, 2017

Your Name (To Appear on the Program)

Mailing Address

Contact Information

Description of item (size, colour, number, etc):

Donor's Name:

Volunteer's Name:

Item Retail Value:

Item Ready for Pick Up?
 Yes No

Date