Honor a Nurse Registration Honor A Nurse Sponsor Form Presented by Marshall Foundation and The Mathewson-Bonser Nursing Scholarship Fund. A Celebration of Excellence in Nursing! To honor the nurse of your choice, at Marshall or elsewhere, simply complete this form. The nurse or nurses that you choose will receive special recognition letting them know that you appreciate their caring and compassionate ways. Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Phone (Home)*Phone (Work)Email* Enter email address to receive confirmationPlease complete the following for up to five nurses. If you have more than five nurses to honor please call us at 530-642-9984 or submit two forms. We also ask that you provide a quote about your nurse. While this is optional, it will help us honor the nurse more appropriately at our annual event.Honor A Nurse Sponsorship Opportunities*Exclusive Executive Sponsor - $5,000 Recognition includes the executive sponsor’s name & logo on all printed materials as well as on the commemorative item given to all Marshall Medical Center nurses and event attendees. The sponsor’s name is prominently recognized on our website, on the invitations, flyers, press releases, event program, and in the Hallway of Honors at Marshall Hospital. A special recognition piece is presented to this sponsor at the event.Excellence in Nursing Sponsors - $2,500 Recognition includes the sponsor’s name prominently recognized on our website, flyers, press releases, event program, and in the Hallway of Honors at Marshall Hospital. A special recognition plaque is presented to this sponsor at the event.The Nightingale Sponsors - $1,000 The sponsor’s name is prominently recognized on our website, flyers, press releases, event program, and in the Hallway of Honors at Marshall Hospital. A special recognition certificate is presented at the event.The Clara Barton Sponsors - $500 Recognition includes acknowledgement in the event program as well as the Hallway of Honors at Marshall Hospital. Sponsors receive appreciation on our website and may honor up to three nurses/nursing groups.The Physician/Good Samaritan Sponsors - $250 Recognition includes acknowledgement at the Honor-A-Nurse Event as well as in the Hallway of Honors at Marshall Hospital. Sponsors receive appreciation on our website and are allowed two opportunities to sponsor a nurse of their choice.Pay-It-Forward Nurse Sponsors - $150 Open only to past scholarship recipients: Recognition includes display board acknowledgement at the Honor-A-Nurse Event as well as in the Hallway of Honors at Marshall Hospital. Includes a certificate of sponsorship. Appreciation on our website and an opportunity to sponsor a nurse of their choice.Compassionate Care Donors - $100 Donors who honor a nurse are recognized on the display boards at the event.Nurse's InformationNurse's Name Full Name Is this gift in memory of this nurse?YesNoPlease list people we should inform of this recognition. Also use the space below for a quote about this nurseAdd a second nurse?YesNo2nd Nurse's InformationNurse's Name Full Name Amount ($) Is this gift in memory of this nurse?YesNoPlease list people we should inform of this recognition. Also use the space below for a quote about this nurseAdd a third nurse?YesNo3rd Nurse's InformationNurse's Name Full Name Amount ($) Is this gift in memory of this nurse?YesNoPlease list people we should inform of this recognition. Also use the space below for a quote about this nurseAdd a fourth nurse?YesNo4th Nurse's InformationNurse's Name Full Name Amount ($) Is this gift in memory of this nurse?YesNoPlease list people we should inform of this recognition. Also use the space below for a quote about this nurseAdd a fifth nurse?YesNo5th Nurse's InformationNurse's Name Full Name Amount ($) Is this gift in memory of this nurse?YesNoPlease list people we should inform of this recognition. Also use the space below for a quote about this nurseTotal amount to be charged $0.00 Payment Type*VisaMastercardAmerican ExpressDiscoverCard Account #*3 Digit Security Code*Expiration Month*01 - January02 - February03 - March04 - April05 - May06 - June07 - July08 - August09 - Septemeber10 - October11 - November12 - DecemberExpiration Year*20152016201720182019202020212022202320242025Name of Cardholder, as it appears on the Card: Full Name ALL GIFTS ARE TAX DEDUCTIBLE TO THE EXTENT ALLOWED BY LAW. If you have any questions regarding giving options, please call: 530-642-9984 - Jamie Johnson, Executive Director Please check with your attorney or other professional advisor for specific financial benefits to you. Ask us about Leaving Your Own Legacy in support of "programs that care for people."
