Auction Item Donation

Fields marked * require an entry.

AUCTION ITEM DONATION

The SIH Foundation will be hosting an auction at the Gala. If you are interested in donating an item, please fill out the information below and a committee member will be in contact to arrange a pick up time of your auction item donation.

Thank you for your generous donation and support of Southern Illinois Healthcare and the SIH Foundation. We are very appreciative.

Item Information

Item Name:*

Estimated Value $:*

Item Description:*

Notes:

I am a(n):*

Individual Donor

Business Donor

I would like to remain anonymous:*

Yes

Contact Information

Company:*

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Work Phone:

Email:*

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