Donation Form

Name(s) of Donor as it is to appear in Catalog: Winery/Business Name(if different from above): *Contact First Name and Last Name: *Email: Telephone: Fax: *Mailing Address:

*Sponsor/Donation Type:

Wine

Quantity	Bottle/Case	Size	Vintage	Description	Value

Type	#People	Expiration Date
Tour/Tasting for	people.
Dinner/Lunch for	people.
Lodging for	Night(s) for people.
Monitary Donation for	$. Checks payable to "HARC."
Other (please explain)

Total value of non-wine contribution:

Delivery

Donor will ship to:

NYIWA 2012 c/o HARC
350 S. Washington Street
Herkimer, NY 13350

If you would like to make other arrangements for shipping please contact us.

	Sponsorship Level	Amount
	Event Sponsor	$10,000
	Tasting Sponsor	$5,000
	Chateau	$3,000
	Vineyard	$2,000
	Winery	$1,500
	Wine Cellar	$750
	Wine Barrel	$500