Minuteman Implant Club
6th Biennial Northeast Cochlear Implant Convention
July 10-12, 2009 – Sturbridge Host Hotel, Sturbridge

AUCTION DONOR FORM

Contact Name____________________________________________________

Company (if applicable) ____________________________________________

Street__________________________________________________________

City____________________________________________________________

Work/Home Telephone____________________________________________

Email__________________________________________________________

Description of Donated Item(s):

                                      Value $:__________________

Name to Appear for Recognition: ____________________________________________

Please return this donation form to:

Marcey Hunter
c/o Minuteman Implant Club
18 Rutgers Road
Wellesley, MA  02481
781-235-8758
dmhunter@comcast.net