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About Woman's
Wall of Stars Order Form
By purchasing a $150 nameplate for the Wall of Stars, you honor the birth of a child in a memorable way and also make a donation to Woman’s Hospital. The tax deductible portion of your gift enables Woman’s to fund programs that improve the health of women and infants.

(First Name)

(Last Name)
No Yes
Butterfly Bunny Star Bear Duck
Pink Blue
Child’s Information: Please note that all inscriptions are limited to the child’s name and birth date. The amount of character space available is determined by the choice of motif.

 
Character Limitations Butterfly Bunny Star Bear Duck
1st Line 17 7 13 11 15
2nd Line 12 13 13 14 15
3rd Line 11 12 11 8 12

Please notify the following individual(s) of my gift:
No Yes
A gift in the name of your own special star will help thousands of future stars! Each 3.5” x 3.5” magnetic nameplate is displayed on the Wall of Stars for your gift of $150.

(no spaces or dashes)

(MMYY)
I am interested in supporting Woman’s Hospital in other ways.
Yes No