Your Miracle Maker Activity Report

The Children’s Organ Transplant Association is very grateful for the time and effort you spent organizing a COTA Miracle Maker activity. Please complete this form so COTA can add your activity to COTA Miracle Maker results from across the country.

Thank you for Giving Hope and Making Miracles!

*Required information

First Name: *
Last Name: *
Organization or Company Name: *
Your Position:
Address: *
City: *
State: *
Zip Code: *
Email: *
Phone: *
Report of your COTA Miracle Maker Activity
Date of Activity: *
Location of Activity: *
Description of Activity: *
Number of people attending activity: *
Number of volunteers: *
Number of donors added to donor list(s): *
Media coverage: *
Are photos available?: *
Did you use tools, tips or resources provided by COTA?: *
If yes did you find these materials helpful?: *
What COTA resources did you find most helpful?: *
What resources would you suggest COTA provide in the future?:*
Amount you plan to raise: *
Have funds been sent to COTA?: *
Have funds been deposited into a COTA bank account?: *
If yes, which account?:
Contact me with more opportunities to help COTA give hope and make miracles: *

If you have not yet sent or deposited activity proceeds:

Cash may be deposited in one of these COTA bank accounts:

Chase
COTA Miracle Makers
Account Number: 2917125714

Bank of America
COTA Miracle Makers
Account Number: 2290 0820 9370

Wachovia Bank
COTA Miracle Makers
Account Number: 3000025117027

Wells Fargo Bank
COTA Miracle Makers
Account Number: 6733374216

Checks may be mailed to:

One Million Miracles
Children's Organ Transplant Association (COTA)
2501 West COTA Drive
Bloomington, Indiana 47403

Giving Hope:

“COTA kept us out of bankruptcy; COTA helped us when I was staying at the hospital caring for Christin and unable to work. COTA took my worries and stress away so I could devote all of my time and energy to help Christin get well … and that gave me hope that everything was going to be OK for my three daughters and me.”

COTA MIRACLE MAKERS

COTA

GIVE HOPE

MAKE A MIRACLE

Your Miracle Maker Activity Report

Report of your COTA Miracle Maker Activity

If you have not yet sent or deposited activity proceeds:

Checks may be mailed to:

Giving Hope:

Kathy Kubicek, Mother of Christin