IOH Auction Donation Form

IOH Auction Donation

ADHA's Foundation: Institute for Oral Health

Benefit Reception Auction Donation Form 



IOH Benefit/President's Reception Event Details:

Date: Friday, June 19   

Time: 7:30 p.m. - 11:00 p.m. 

Location: Country Music Hall of Fame

Cost: $55 per ticket



Important Information: 

  • Thank you for your auction item donation. Please complete this form and review the important information below.
  • May 15: Deadline to complete the auction donation form
  • May 15: Deadline to send donated item to ADHA's Central Office in Chicago
  • May 15: jpeg photo of auction donation sent to
  • June 18: Deadline to drop off donation items to ADHA's office in room 204 of the Music City Center Convention Center
  • NOTE: No auction donations will be accepted after the May 15 deadline
  • NEW! IOH will be launching an online mobile bidding feature. The auction will open online approximately one week prior to the June 19 event
  • Mailing Address:  If you indicated you are mailing our auction donation in advance, please use the mailing address below:  

                                                                               ADHA IOH Auction Item

                                                      444 N. Michigan Ave, Ste. 3400, Chicago, IL 60611

Item Name: *
Item Description: (35 words or less) *
Item Fits Best into the Following Category: *
Retail Value: *
Please indicate how we will receive your item: *
Auction Item Donated by: (The person/organization indicated below will receive a tax letter for and be thanked in the Donor Honor Roll)
Donor First Name: *
Donor Last Name: *
Donor Address: *
Donor City: *
Donor State: *
Donor Zip: *
Donor Cell Phone: *
Donor Email Address: *
Donor ADHA Member Number (if applicable):

A photo of your donation item must be sent by May 15 to *
I verify that all the information provided above is accurate. *
Be sure to print a copy of this submission form and remit a copy of this form with your actual donation item.
Questions? Contact ADHA Insitute for Oral Health at