2021 DLM Collateral 2

Deadline: Feb. 26, 2021 Fill out a separate form for each hospital.

2021 DLM Collateral Form

* Indicates required field

Your Name *

Hospital Name *

Hospital Code

VIRTUAL GUEST SPEAKER

Speaker *

Yes, I want a virtual speaker.

Event Date *

Event Time *

GIVEAWAY REQUESTS (total quantities will reflect your hospital code allocated amounts)

T-Shirt Qty. Per Sizes

Small *

Medium *

Large *

XL *

2XL *

3XL *

Lapel Pin Qty. (if less than allocated amount) *

Sucker Qty. (if less than allocated amount) *

LIFESHARE DLM MATERIALS

Posters Qty. *

Web Banner - size needed *

Donation Champion Hospital Certificates - Certificate Deadline March 1, 2021

Name and Credentials *

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