Auction Item Donation Form

The Parents Club has received $352.09 as of June 2022 as a result of your AmazonSmile Impact. The latest donation was $41.95 for one quarter! You can find us under "Parents Club of the University of Arkansas College of Medicine" on AmazonSmile. Please sign up today!

Donor Information

"*" indicates required fields

Name*

Company

Phone

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Description of donated items*

Approximate retail value of donation:*

A Parents Club member is needed to pick up donated item:

Yes

No

I am unable to attend this year, but would like to donate

Donation Amount:

(donations are fully tax deductible)

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Payment Method*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

The UAMS Parents Club is a 501(c)(3) non-profit organization

TAX ID #93-0674121

P.O. Box 250226, Hillcrest Station,
Little Rock, AR 72205