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




Payment Option
Credit Card Information
Visa MasterCard American Express Discover

Visa®, Mastercard® & Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

Your total payment will be