Third Annual KH 6515 Wine Donation Form
User Manual: KH 6515
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A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE
WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. THE TOLL-FREE NUMBER IS 1 (800) 435-7352.
1265 Northwest 12th Avenue Miami, FL 33136 Tel 305.547.6800 Fax 305.547.6816 www.kristihouse.org
Name:
Company (if applicable):
Address:
City: State: Zip:
Phone (s):
Email:
Name for Publication:
(EXACTLY how you wish it to appear in print)
I prefer to donate anonymously.
# of Bottles
Bottle Size
Vintage
Value
Wine Description:
# of Bottles
Bottle Size
Vintage
Value
Wine Description:
# of Bottles
Bottle Size
Vintage
Value
Wine Description:
Donor Signature: Date:
For more information, contact Wine co-chairs Kara Zeder (kzeder@gmail.com 305-458-6515),
Dana DeMaria Nateman (ddemaria@truckmax.com 305-777-9024
Or at Kristi House, Mary Faraldo (mfaraldo@kristihouse.org 786-218-9748)
Wine Donation
15th Annual Touch a Heart Dinner & Auction
Friday, November 14, 2014, 7:00 p.m.
The Four Seasons Hotel • Miami, Florida
