AHIMA Foundation AHIMA Foundation
2012 SILENT AUCTION
 

 

September 29 - October 3, 2012

 
AUCTION DONATION RESERVATION FORM

To reserve your spot in the auction showcase and have your donation acknowledged in the convention program, please complete and return this form by Monday, July 23, 2012.

A monetary donation may be made in lieu of an auction item.

Monetary donations of $300 and above will be acknowledged as auction donations in the convention program (if received by Monday, July 23, 2012) and on other convention and Foundation materials. Simply indicate you are making a monetary donation in the Suggested Title field and state the amount in the Donation Value Field. Then you can mail or submit your donation online (visit the Foundation website for information on how to donate).

*Indicates Required Fields  

Section 1: Donor Information

  
   
Donor Name* 
 
Donor Street Address*
 
Suite
 
City*
State*
Zip*
v
  		 
     

Section 2: Contact Information

  
     
Contact Full Name*
 
Daytime Phone Number*
Format: XXX-XXX-XXXX 		 
Daytime Phone Extension
 
E-mail Address*  
 
Retype E-mail Address*
 
     

Section 3: Item Donation Information

  
     
Suggested Title of the Donated Item(s)*
This title will be printed on the auction item bid sheet. 		   
Description of Item(s) to be Donated *
This description will be printed on the auction bid sheet. If you are submitting a package/basket of items, please list each item included. 		 
 
Item Category *
v
 
Are there any restrictions with this item? (e.g., certificate or subscription, valid dates of use)

If yes, please explain:
  
Donor’s Estimate of Fair Market Value of this Donation*
The value of any item, regardless of the amount, is used for internal gift reporting only - AHIMA Foundation is unable to include the estimated value on a donor receipt or acknowledgement. It is the responsibility of the donor to substantiate the fair market value for his/her own tax purposes.
Format: $X,XXX.XX 		 
 

Preview and Submit

  
     
Once this form is submitted, all changes must be communicated to Mary Taylor-Blasi for input. Please direct all questions to info@ahimafoundation.org (312-233-1585).
   
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