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* 1. Name

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* 2. Agency (if applicable)

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* 3. Street Address

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* 4. City, State Zip

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* 5. Email

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* 6. Phone

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* 7. Donation Type(s)

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* 8. Thank you for your generosity in making a cash donation.   Please list amount pledged.

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* 9. Thank you for your generosity in donating a basket / prize for our auction.    Please briefly describe prize below.

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* 10. Thank you for your generosity in donating a gift certificate prize for our auction.   Please list below the amount of the gift certificate and where the certificate can be used.

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* 11. Donations are requested to be in the COGI Office by Friday, October 27, 2017.   How will your donation arrive?

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* 12. Donations may be mailed to or dropped off at COGI, 437 North Centre Street, Pottsville, PA 17901.  

Checks should be made payable to "COGI".

If you requested to have your donation picked up, please notate where and when your donation will be available.

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