AHIMA Foundation 2009 NOT-SO-SILENT AUCTION
HELD IN CONJUNCTION WITH THE AHIMA CONVENTION/EXHIBIT OCTOBER 3-8, 2009
RESERVATION FORM FOR AUCTION DONATION

To reserve your spot in the showcase and have your item acknowledged in the convention program
please complete and return this form by Monday August 3, 2009

Are you making a monetary donation in lieu of providing an auction item?

If so, please CLICK HERE to use our secure online donation form.

Monetary donations of $300 and above received by August 3 will be acknowledged in the Convention Brochure and the Auction Catalog—this is an effective way for corporations not exhibiting to reach the AHIMA convention audience!

Required Fields indicated by "*"  

Section 1: Donor Information

  
   
Donor Name*
(Individual/CSA/Corporation*)		  
Donor Street Address*  
Suite  
City*, State*, Zip*  
     

Section 2: Contact Information

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

Section 3: Item Donation Information

  
     
Suggested Title of the Donated Item(s)
(May mark TBD and provide date for completion prior to 8/3/09)		  
Description of Item(s) to be Donated
(If you are sending a grouping of items, please provide a detailed listing of all items by August 3)		  
If a Certificate/Subscription, etc. Note Dates Item is Valid:  
Any Restrictions?

Yes     No

If yes, please explain:
  
Donor’s Estimate of Fair Market Value of this Donation Format: $X,XXX.XX  
   

Preview and Submit

  
     
Depress the ”Next” button to preview your submission; if all the information is correct, you may then submit it to the AHIMA Foundation.
     

QUESTIONS ABOUT THE AHIMA FOUNDATION NOT-SO-SILENT AUCTION SHOULD BE DIRECTED TO:
janice.mackovitch@ahimafoundation.org; 312/233-1968
Visit our Web site at http://www.ahimafoundation.org/support/auction.aspx