Honor a Nurse Registration

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone (Home)*

Phone (Work)

Email*

Enter email address to receive confirmation

Please 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 recognize 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 Information

Nurse's Name

Full Name

Is this gift in memory of this nurse?

Yes
No

Please list people we should inform of this recognition. Also use the space below for a quote about this nurse

Add a second nurse?

Yes
No

2nd Nurse's Information

Nurse's Name

Full Name

Amount ($)

Is this gift in memory of this nurse?

Yes
No

Please list people we should inform of this recognition. Also use the space below for a quote about this nurse

Add a third nurse?

Yes
No

3rd Nurse's Information

Nurse's Name

Full Name

Amount ($)

Is this gift in memory of this nurse?

Yes
No

Please list people we should inform of this recognition. Also use the space below for a quote about this nurse

Add a fourth nurse?

Yes
No

4th Nurse's Information

Nurse's Name

Full Name

Amount ($)

Is this gift in memory of this nurse?

Yes
No

Please list people we should inform of this recognition. Also use the space below for a quote about this nurse

Add a fifth nurse?

Yes
No

5th Nurse's Information

Nurse's Name

Full Name

Amount ($)

Is this gift in memory of this nurse?

Yes
No

Please list people we should inform of this recognition. Also use the space below for a quote about this nurse

Total amount to be charged

$0.00

Payment Type*

Visa
Mastercard
American Express
Discover

Card Account #*

3 Digit Security Code*

Expiration Month*

Expiration Year*

Name 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."

Honor A Nurse Sponsor Form

Nurse's Information

2nd Nurse's Information

3rd Nurse's Information

4th Nurse's Information

5th Nurse's Information