Fields marked * require an entry.

Donate an item to our Gala auction by completing the fields below. Please note that medical services, cosmetic procedures, diabetes management tools and items on consignment are not accepted in our auction. JDRF accepts only new and unused items. Antiques should be accompanied by a recent appraisal. If you have any questions, please contact Michelle Plyem at 202-465-4114. Thank you!

Donate an Auction Item

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

No

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*

Donate an Auction Item

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