Request for Donor and Memorial Plaques

Request for Donor and Memorial Plaques
Thank you for your inquiry regarding a donor or memorial plaque that was displayed at St. Elizabeth Medical Center or St. Luke’s Hospital between November 2022 and October 2023.

If you would like to request to receive your plaque or recognition item, please complete the following information by July 31, 2025, and Delta Rubsamen, Gift Inventory Coordinator with the MVHS Foundation, will be happy to follow up with you.

Please note that requests received from January 21 to February 20, 2025 when Delta will be out of the office will be followed up after her return.
Your Name:*

First NameLast Name
Your Email:*
example@example.com
Your Phone Number:*
Please enter a valid phone number.
Name of the Donor or Person Memorialized:*
Your Relationship to the Donor or Person Memorialized:*
Description of the Plaque:*
Location of the Plaque:

St. Elizabeth Medical CenterSt. Luke’s Hospital
If known, the Floor Location of the Plaque:
If known, the Department Location of the Plaque:
Additional Comments:
Should be Empty: