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DME, Members

HMP DME Services

Kelly Isola2024-11-21T05:12:42-06:00

HMP DME ServicesKelly Isola2024-11-21T05:12:42-06:00

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Annual Luncheon Sponsorship

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Event Sponsor's Name *

Business/organization/individual

Name of Contact *

First

Last

Contact's Email *

Contact's Phone Number *

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Level of Event Sponsorship *

Platinum Sponsor - $500.00
Gold Sponsor - $400.00
Silver Sponsor - $300.00
Bronze Sponsor - $200.00

Total

$0.00

Credit Card *

Logo Upload

Click or drag a file to this area to upload.

If you're an event sponsor, please upload your logo here in either AI. PDF. or any type of vector file.

Outstanding Physician Award

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Name and Position/Title of Nominee *

Agency *

Person Submitting Nomination *

First

Last

Phone *

Email *

Reason(s) for Nomination *

Barbara Johnson Education Award

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Name and Position/Title of Nominee *

Agency *

Person Submitting Nomination *

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Last

Phone *

Email *

Reason(s) for Nomination *

Marilyn Bockelman Community Award

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Name and Position/Title of Nominee *

Agency *

Person Submitting Nomination *

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Last

Phone *

Email *

Reason(s) for Nomination *

Noni McCall Legislative Award

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Name and Position/Title of Nominee *

Agency *

Person Submitting Nomination *

First

Last

Phone *

Email *

Reason(s) for Nomination *

Outstanding Associate Award

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Name of Outstanding Associate *

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Last

Agency *

Position/Title *

Person Submitting Nomination *

First

Last

Reason(s) for Nomination *

Annual Luncheon RSVP

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KCRHCA Member *

Name *

First

Last

Email *

Phone *

Total number attending

How many vegetarian meals

Single Item

Price: $25.00

Credit Card *

Richard Sanders Extra Mile Award

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Name and Position/Title of Nominee *

Agency *

Person Submitting Nomination *

First

Last

Phone *

Email *

Reason(s) for Nomination *

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