Donation Submission Form

Fundraiser Information

Name:

Team Name (if applicable):

For each offline donation made, please complete a line in the chart below. Include the donor's name, complete mailing address, donation amount, check number and also indicate if you have logged this donation in your Participant Center.

If this form is not complete, if inaccurate information is provided or if the donations associated with the form are not included, we cannot guarantee that donations will be confirmed or that your donors will receive an acknowledgment letter.

Total Amount Enclosed

Total Number of Checks Enclosed

Do not send cash—convert to money order or check. Please make all checks payable to JDRF and write your name and when appropriate, "Cash converted to check" in the memo section of each check to ensure the donation is accurately credited to your fundraising efforts.

Donor's Name

Address

Donation Amount

Check #

Logged in Participant Center?* (yes/no)

If you entered the donation in your Participant Center through the "Log Cash / Checks" page on the Dashboard tab, please let us know so that we can properly match up the funds with your entry and ensure you get the appropriate credit.

After we have received and processed your completed form along with the applicable donation(s), your donor(s) will receive their acknowledgement letter for tax purposes.

If you have any questions or would like more information, please contact us at walk@jdrf.org or call 888-533-WALK. Thank you for your support!

JDRF Internal Use Only

4134646240400000

Chapter #: 4134	Event Code: 6462
Team ID:	TeamRaiser ID: 3279
Constituent ID:
Event: Brevard 2014 Walk to Cure Diabetes