auctiondonorform2006

NAMI Pennsylvania
Annual Conference 2006: October 26-29
Radisson Penn Harris Hotel, Harrisburg PA
Health, Home and Community: Access to Quality Life

Name:

Organization:

Address:

City:

State:

Zip:

Phone:

Fax:

Email:

Affiliate:
(if applicable)

County:

Complete Description of
Item Being Donated:

Value of Item
Being Donated:

Suggested Minimum Bid:

Name of Individual or
Organization to be listed
in the Auction Booklet as
donor:

Address to send
acknowledgement
if different than above:

Any special requirements
or Restrictions for the
Donation:

Donation Solicited By:
(NAMI member)