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Contribution Commitment

Mid-Cities Care Corps


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November 4, 2010
6:00 – 9:00 P.M.
Hurst Conference Center
1601 Campus Drive
Hurst, TX
Contributor or Company Name:____________________________________________

Contact Name:________________________________Phone:_____________________

Address:_______________________City:_______________State:_____Zip:_________

Item(s) Description Estimated Retail Value

_______________________________________________ ______________________

_______________________________________________ ______________________

_______________________________________________ ______________________

_______________________________________________ ______________________

YOU MAY FAX YOUR COMPLETED FORM TO 817-282-7980


www.midcitiescarecorps.org

Do we need to pick the item(s) up? Yes No

For Office use only: Date Received:_______________Received by:___________

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