Sep 13, 2017 - Proceeds from the Auction go to funding vital programs for ASDS members ... Fax: 847-956-0999 ⢠Phone:
ASDS MEMBERS 2017 ASDS ANNUAL MEETING SILENT AUCTION DONATION FORM Deadline to be listed in the Silent Auction brochure: September 13, 2017
C
OC TOBER 5-8
ASDS Annual Meeting • October 5-8, 2017 Hyatt Regency Chicago • Chicago, IL
Help us reach our goal of $100,000 in 2017 by donating to the Silent Auction. Proceeds from the Auction go to funding vital programs for ASDS members and residents. Your support will be recognized in the Final Program, the Silent Auction brochure and various onsite materials. Company Name____________________________________________________________________________________________________________________________ Contact Name_____________________________________________________________ Title ______________________________________________________________ Address:____________________________________________________________________________________________________________________________________________ City________________________________________________________ State/Province________________________________ ZIP/Postal Code______________________ Phone __________________________________________________________________ Fax______________________________________________________________ Email______________________________________________________________________________________________________________________________________ Member ID # ____________
Date Submitted ____________________
Yes, we would like to make a donation to the 2017 ASDS Annual Meeting Silent Auction. ■
Members are asked to bring their donations to the Silent Auction booth #625 in the exhibit hall during set-up on Thursday morning, October 5, between 7 – 11:30 a.m. A wide range of items may be donated to the auction; such as concert & sporting event tickets; small electronics, artwork and paintings, gift baskets, fine jewelry, restaurant and department store gift certificates, fine and unique wines, certificates for "a day with a doctor", surgical instruments, collectibles and memorabilia, hotel stays, vacation/spa packages or any other item you choose to name a few.
Please indicate item category: q 100 Artwork q 200 Business Merchandise o FDA requires this item may be purchased ONLY by a U.S. physician
q 300 Educational Programs/Publications q 400 Personal Merchandise q 500 Services q 600 Travel
In addition to this donation form, please email a photo of your donation to Helen Prostko at
[email protected] for inclusion in the Silent Auction brochure. Submissions made to the ASDS Silent Auction are tax deductible. You may deduct the value of the item(s) you are donating.
Donation Description Estimated Value $___________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Please submit this form by Wednesday, September 13, 2017, to: Helen Prostko, Development & Industry Relations Specialist American Society for Dermatologic Surgery 5550 Meadowbrook Drive, Suite 120 • Rolling Meadows, IL 60008 Fax: 847-956-0999 • Phone: 847-956-9140 •
[email protected] 