Honoring local Healthcare Workers Order Form
Has a healthcare worker made a difference in your life or the life of someone you love? Send them a gift to let them know how appreciated they are. On Friday, May 14th, we will deliver gifts to your honored healthcare workers to their place of business.

Your $10 gift will include a personalized note and an Angel Wings pin - honoring a healthcare worker for being an angel on earth.

Payment can be made by:
-Check or cash - mailed to or dropped off at: The Salvation Army, 89 Franklin St. Waterloo, IA 50703
-Electronic payment - www.sawaterloo.org (click on the "donate now" button)
-Credit Card in-person payment by stopping by The Salvation Army, 89 Franklin St.

Thank you for supporting our wonderful Healthcare workers and also The Salvation Army.
Your Name *
Your Email *
Your telephone number *
Name of the Healthcare Worker you want to honor (one form/healthcare worker) *
Place of Healthcare worker's employment *
Address of Healthcare worker's employment (we will deliver to healthcare facilities in Waterloo and Cedar Falls) *
Message you would like to share with the Healthcare worker:
This is an example of what the gift will look like:
Captionless Image
How will you be providing payment for this gift: *
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