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NHCA Care PAC Contribution Form - 2021

Step 1 of 4

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  • Contributor Information

  • Contribution Information

  • Please note:

    If you are an individual, you can choose a Club Membership based on your contribution level. This is available to member facility employees, corporate office staff, owners, as well as individual members. Proprietary member facilities can participate at a suggested $2 per bed or more. Non-profit or government facilities should consult with a tax professional prior to contributing.
  • Proprietary Member Facility Per Bed Contribution

  • Contribution suggested at least $2 per bed.
  • Please enter a number greater than or equal to 1.
  • $0.00
  • Member Facility/Company Contribution

  • $0.00
  • Individual Contribution

  • $0.00
  • Your Contribution Level is:

    Contributor Club
  • Your Contribution Level is:

    Leadership Club
  • Your Contribution Level is:

    Advocate Club
  • Your Contribution Level is:

    Capitol Club
  • Your Contribution Level is:

    Silver President’s Circle
  • Your Contribution Level is:

    Gold President’s Circle
  • Your Contribution Level is:

    Platinum President’s Circle
  • Contribution Levels

    President’s Circle
    ● Platinum President’s Circle $5,000 or more
    ● Gold President’s Circle $2,500-$4,999
    ● Silver President’s Circle $1,000-$2,499
    Capitol Club $500-$999
    Advocate Club $200-$499
    Leadership Club $50-$199
    Contributor Club $10-$49
  • Please select the contributor category that best describes you.
  • Payment Information

  • $0.00
  • For recurring donations, please contact NHCA at 402-435-3551.

  • Credit Card Information

  • American Express
    Discover
    MasterCard
    Visa
     
  • Review Your Selections

    Click "Previous" to make changes. Click "Submit" to process your registration(s). {all_fields} After clicking on "Submit", please wait. It could take a bit to process. You will be redirected to a new screen when the transaction has been completed.
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