Hospital Interest Form

Thank you so much for your help in spreading the word about such a special part of what we do! 

We are so excited to send out more of our Burial Gowns and Burial Pockets! 

Our goal is that every hospital in Wisconsin large or small would have a stock on hand of special and carefully assembled of gowns and pockets. 


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What is your FULL name? *
What is your email address? *
What is the name of the hospital that you feel like could benefit from this program?
 *
What is their phone number?
 *
What is the hospitals address?
 *
Do you have a primary contact for the hospital that you know of or have talked to about this program? *
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