Detroit District Dental Society Door Prize Donation Form

The Detroit Dental Society appreciate the support of our dental community in increasing the fun factor and participation at our events.  This form is to notify us of a door prize donation for an upcoming event. 
Which event are you donating a door prize to and please note you can include promotional materia and information in the item.

Name of contact person for this donation
Please enter email.
We hope to make the coordination of this donation as easy as possible for getting the item to our event. Please select the best options for your delivery. More than one selection can be made.

We do have to provide an accounting record for all donations. Please give an estimate for dollar value of donation. If no dollar amount is given the estimate will be $20.00 or best information available