Friends Foundation Medical Office Building Naming Rights Campaign
benefitting Ste. Genevieve County Memorial Hospital

Naming Rights Opportunities: In addition to the options below, other naming opportunities include: Nurses Stations ($10,000); Conference Room ($25,000); Clinic Waiting Area ($50,000); Courtyard ($75,000); Medical Surgical Unit ($100,000); and Medical Office Building ($500,000). Please call Holli Ledbetter directly if interested in these naming rights (573-883-7725).

Please include names for whom the following will be named in the comment box below.

4x8 Courtyard Brick - $150.00

12x12 Courtyard Brick - $250.00

Bench - $500.00

Artwork - $1,000.00

Medical Surgical Patient Room - $2,500.00

Medical Office Exam Room - $2,500.00

Physical Therapy Room - $5,000.00

Respiratory Therapy Room - $5,000.00

Date:

04/25/24

4x8 Courtyard Brick - $150:

Quantity

12x12 Courtyard Brick - $250:

Quantity

Bench - $500:

Quantity

Artwork - $1,000:

Quantity

Medical Surgical Patient Room - $2,500:

Quantity

Medical Office Exam Room - $2,500:

Quantity

Physical Therapy Room - $5,000:

Quantity

Respiratory Therapy Room - $5,000:

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Total Charge:

Credit Card Information:

Card Type:

Name as on Card:

Card Billing Address:

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Card Expiration Date:

MMYY

Card ID (CVV2/CID) Number:
[What is the Card ID?]

Additional Contact Information:

Phone Number:

Email Address:

Email Address (to confirm):

Additional Comments