Women Helping Women Registration

Name *

Address *

City *

State *

Zip Code *

Phone *

Email *

Number of Tickets ($80.00 each)

Event Sponsors

I would like to sponsor Women Helping Women.

Sponsor Level

Birthday Sponsor - $2,500 (8 guests)

Gold Sponsor - $1,000 (8 guests)

Silver Sponsor - $500 (4 guests)

Bronze Sponsor - $350 (2 guests) pays for one mammogram

Guests

Guest #1

Guest #2

Guest #3

Guest #4

Guest #5

Guest #6

Guest #7

Guest #8

Event Donors

I am unable to attend but wish to support Women Helping Women with a donation.

Donation Amount

Donation Dedication:

In honor of

In memory of

Dedication Name

Billing Information

*=Required Field

Card Holder *

Company

Contact Phone *

Email Address *

Billing Address *

City *

State *

Zip Code *

Total Amount

Credit Card *

Month

Additional Information:

I have included Hancock Regional Hospital Foundation in my estate plans

Please send me information on planned giving opportunities

I wish to remain anonymous for all recognition purposes

I would like foundation staff to contact me about gift opportunities

Details regarding the sponsorship levels are available online or by contacting Allyson Smith at (317) 468-4106 or asmith@hancockregional.org.

REFUND POLICY: If you made a donation in error, you have the right to a full refund within 30 days of the date of the donation. Contact Hancock Regional Hospital Foundation at 317-468-4583 should you require assistance in this situation.

Event Tickets

Event Sponsors

Guests

Event Donors

Billing Information