2023 DLM Collateral Form

Drag & Drop elements for the Sidebar here

Deadline: Feb. 16, 2023 Fill out a separate form for each hospital.

COLLATERAL FORM IS NOW CLOSED FOR ENTRIES - Please do not enter any information below.

* Indicates required field

Your Name *

Hospital Name *

Hospital Code

Select Code - This will impact your allocated giveaway items. *

Super A A Transplant Center B C D E F

GUEST SPEAKER

REQUEST *

In Person Speaker Virtual Guest Speaker Recipient for Rounds

Event Date *

Event Time *

Location *

GIVEAWAY REQUESTS (total quantities should not exceed your hospital code allocated amounts)

T-Shirt Qty. Per Sizes

Small *

Medium *

Large *

XL *

2XL *

3XL *

Lapel Pin Qty. *

LIFESHARE DLM MATERIALS

Poster Qty. *

Table Tent Qty. *

Flyer Qty. *

Web Banner - size needed *

Donation Champion Hospital Certificates - Certificate Deadline March 1, 2023

Name and Credentials *

Order Now

LifeShare Network, Inc.
4705 NW Expressway • Oklahoma City, OK 73132
(405) 840-5551