New England HIMSS Silent Auction Donation Form

When disaster strikes, community comes together. Whether it’s a hurricane, wildfire, tornado, or any other crisis, NE HIMSS would like to help our HI professionals rebuild in disaster areas. Your donation to our silent auction will be directly donated to the American Red Cross for disaster relief. Your support can make all the difference for those facing tough recovery efforts.

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* 1. DONOR/COMPANY NAME as it will appear in Auction Item

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* 2. DONOR CONTACT NAME:

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* 3. DONOR CONTACT PHONE

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* 4. DONOR CONTACT EMAIL

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* 5. NAME OF ITEM OR SERVICE DONATED:

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* 6. DESCRIPTION (be detailed & specific, including all information necessary to prepare a program entry about this donation):

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* 7. SPECIAL INSTRUCTIONS / RESTRICTIONS ON USE OR AVAILABILITY OF DONATION (expiration, black-out dates, fees, service area, etc.):

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* 8. FAIR MARKET VALUE OF DONATION: $

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