Steve Harvey Registration – Health Care Foundation of North Mississippi

YES! I want attend the Steve Harvey Patrons Event benefitting HealthWorks! at the level indicated below. Additionally, my intent is to continue supporting HealthWorks! annually with a sustaining gift. However, my intent is non-binding and should not be considered as a pledge. I may be contacted annually for additional gift requests.

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone

Name of additional guest (if applicable)

First

Last

Donation Level:

Corporate Patron - $2500

8 pre-event Patrons Party and Steve Harvey's Presentation tickets

Individual Patron - $500

per couple 2 pre-event Patrons Party and Steve Harvey’s Presentation tickets

Sustaining Member - $250

per couple 2 tickets to Steve Harvey’s Presentation

Payment Options *

Pay Online
Invoice

Total

$ 0.00

To complete your registration and pay by credit card, enter the above amount due along with your credit card information on the following pages.

Or print the form above

print

Mail your registration and/or check to:
Health Care Foundation
830 S. Gloster St.
Tupelo, MS 38801

Forms and/or checks may also be dropped off at the HCF office, 1016 N. Gloster St., Tupelo

Contributions to the Health Care Foundation
are tax deductible as allowed by law.

Please contact the HCF office with questions or further assistance:
foundation@nmhs.net or 662-377-3613