Please Retain a Copy of This Form for Your by mallorycarlson

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									                 Please Retain a Copy of This Form for Your Tax Records.

                                                          Foundation for Addictions Nursing
                                                               Silent Auction Donation Form
                                                        IntNSA Annual Educational Conference
                                                              September 30 - October 3, 2009
                                                                                  Hyatt Hotel
                                                                            Albuquerque, NM

COMPANY DONOR: __________________________________________________________

CONTACT NAME: ____________________________________________________________

ADDRESS: __________________________________________________________________

CITY/STATE/ZIP: _____________________________________________________________

TELEPHONE: ____________________________ FAX: ______________________________

Please specify in the description any restrictions such as blackout and expiration dates,
suggested expiration date of November 1, 2010. Examples of donated items may include
personal crafts, jewelry, books, regional items of interest, and sports related items, etc.

DESCRIPTION OF DONATED ITEM: _____________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

ITEM VALUE: $__________               SUGGESTED MINIMUM STARTING BID: $                 ________

WHERE TO RETURN THIS FORM
Return this form to the IntNSA Executive Office by September 11 by faxing it to
(913) 895-4652, emailing it to intnsa@intnsa.org or mailing it to the address at the bottom of the
form. Thank you.

WHERE TO SHIP ITEMS
Please bring donated items with you to the IntNSA Annual Educational Conference, or send the
donated auction item to the following address by September 11:

       IntNSA/FAN Silent Auction
       18000 W. 105th St.
       Olathe, KS 66061.7543 

Thank you for your donation to the Foundation for Addictions Nursing silent auction. The above
item(s) were donated to the Foundation for Addictions Nursing Silent Auction. Donations are
tax-deductible to the extent provided by law.

Foundation for Addictions Nursing 501(c)(3) federal tax ID number is 36-3469005.

IntNSA
PO Box 14846
Lenexa, KS 66285-4846
(877) 6INTNSA (646-8672)
Fax: (913) 895-4652
www.intnsa.org
intnsa@intnsa.org

								
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