Board of Advisors Renewal Reply Form – Give at Newton-Wellesley Hospital

Please complete the information below and submit to the Development Office by Friday, May 20, 2022. Fields with an asterisk (*) are required.

Questions? Please contact the Development Office at (617) 243-6243 or email at nwhdev@partners.org.

Your Name*
First Last
Please select one*
- Yes, I accept the invitation to remain an Advisor for Newton-Wellesley Hospital for a three-year term to expire in 2025.
- No, I am unable to accept at this time.
Please complete the remainder of the form and submit to Development.
Personal Information
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Email*
Preferred Phone*
Spouse Name, if applicable
First Last
Spouse Email, if applicable
Business Information
Employer
Title
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Assistant's Name
First Last
Assistant's Email Address
Assistant's Phone
Please indicate your preference for receiving communications from Newton-Wellesley*
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- Business

Personal Information