Honor a Nurse 2013

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1. Your Name

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2. Your Street Address

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3. Your City, State, Zip

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4. Your email address

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5. Your Phone Number

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6. Please list names, separated by commas, of the nurse(s) you would like to honor:

In honor of:

In memory of:

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7. Please tell us who to acknowledge this gift to. If you are acknowledging multiple nurses, please put the nurse's name in parenthesis prior to providing a name/address.

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8. A $50 gift honors one nurse, you may list a name for every fifty dollars donated or you may make one larger donation to honor a nurse(s) as you wish. To honor/recognize a group of nurses (2+) a minimum of $100 is expected. My gift amount is:

$50.00

$100.00

$250.00

$500.00

Other (please specify)

Please send check payable to STT Upsilon Alpha Chapter by May 1 to:
Dr. Janet A. Sipple, Chr. Fundraising Comm.
St. Luke’s School of Nursing at Moravian College
1200 Main Street
Bethlehem, PA 18018

Should you have any questions, please contact Dr. Janet Sipple at:
sipplej@moravian.edu
610-861-1608

*No goods or services have been exchanged for this gift.