This form serves as your NHM sponsorship contract. Please initial and date below to verify the agreement between your company and Nebraska Healthcare Marketers.
Pay now by entering your credit card information below or please send payment by check to:
Nebraska Healthcare Marketers
Evie Ranslem Parsons, Treasurer
Sidney Regional Hospital
1000 Pole Creek Crossing
Sidney, NE 69162-1799
Visa®, Mastercard® & Discover® cardholdersYour security code is the 3-digit code at the end of the signature field on your card's back.
American Express® cardholdersYour security code is the 4-digit code located above the actual credit card number on your card's front.