NAME :   ________________________________________________

COMPANY:   _____________________________________________

ADDRESS:   _____________________________________________

CITY/ST:   _____________________________ ZIP:   ____________

PHONE:   _______________________

E-MAIL:   _______________________________________________

Cash or check payable to Hunt of a Lifetime Foundation

Amount enclosed: _______________________

Merchandise donation:

Item(s): __________________________________________________

Fair market value of donation: ________________________________

Do you wish to have a receipt mailed to the above address?   Yes _no

Do you have a banner or sign to lend us to display at the event?  Yes_ no

List additional items and value:





Mail checks to: Hunt of a Lifetime Foundation
                             Jon De Lorenzo
                             604 Mc Creery
                             La Junta, Co 81050

Information: H 719-384-4349     C 719-980-4349

Drop off at: PT'S Guns, Sport and Pawn, in Lamar (Perry Middleton)

Receipt issued (Initial by issuing agent) _________ (Date) __________