Description
INTERNAL FEEDING PUMP
LARYNGOSCOPE-CHILD
PORTABLE SUCTION DEVICE
LEAD APRON
SYRINGE PUMP
INFUSION PUMP
FORCED AIR WARMING SYSTEM
CYSTO URETHRO-FIBERSCOPE
BIPAP
DEFIBRILLATOR
VAC
URETERO FIBERSCOPE
E.C.G MONITOR
OXYGEN SUPPLY AT HIGH FLOW
RATE
LARYNGOSCOPE-ADULT
FETAL MONITOR
BRONCHOSCOPE
GLIDESCOPE
DIATHERMIA VALLEYLAB
TEE TRANSDUCER
FORCE TRIAD ENERGY
GASTROSCOPE
INCUBATOR FOR PREMATURE
INFANTS
RESPIRATOR G5
GYNECOLOGIC ULTRASOUND
MOBILE X-RAY MACHINE
EPIQ 5 ULTRASOUND
ADULT CRASH CART
PEDIATRIC CRASH CART
IV DRIP COUNTER
ADULT RESPIRATORS
PEDIATRIC RESPIRATORS
DOCKING STATIONS
VECTOR BASE
TWO MOMED VIVA
COUGH ASSIST MACHINE
Dedication Amount
$600.00
$650.00
$650.00
$750.00
$2,000.00
$2,250.00
$3,500.00
$6,000.00
$6,000.00
$10,000.00
$7,250.00
$9,000.00
$10,500.00
$10,000.00
$10,000.00
$9,000.00
$10,500.00
$14,000.00
$14,000.00
$32,000.00
$34,000.00
$40,000.00
$52,000.00
$55,000.00
$56,000.00
$180,000.00
$200,000.00
$15,000.00
$15,000.00
$1,500.00
$60,000.00
$60,000.00
$2,500.00
$95,000.00
$7,000.00
$8,500.00
9465 Wilshire Boulevard, Suite 300
Beverly Hills, CA 90212
310-838-0700
PATIENT LIFT
ARMEO POWER
BALANCE TUTOR
ALTER ANTI GRAVITY
CRO THERAPY SYSTEM
E-LINK
ADVANCED PEDIATRIC & NEONATAL
SIMULATORS
ADVANCED ADULT 3G LAERDAL
SIMULATORS
ADVANCED MATERNAL AND
NEONATAL BIRTHING SIMULATORS
SIMBIONIX 3D ANGIOMENTER
2 MOBILE AUDIO-VISUAL UNITS FOR
DEBRIEFING
$10,000.00
$300,000.00
$70,000.00
$78,000.00
$10,000.00
$42,000.00
$70,000.00
$100,000.00
$100,000.00
$200,000.00
$100,000.00
9465 Wilshire Boulevard, Suite 300
Beverly Hills, CA 90212
310-838-0700
SPONSORSHIP FORM
Donor information
Donor Name(s): ______________________________________________________________________
___________________________________________________________________________________
Street Address: _______________________________________________________________________
City: __________________________________ State: _______ Zip: ___________________________
Primary Phone: __________________________ E-mail: ______________________________________
Name of Item Donated
Donation Per Item
Number of Items Donated
 Internal Feeding Pump
$600.00
___
 Laryngoscople-Child
$600.00
___
 Portable Suction Device
$650.00
___
 Lead Apron
$700.00
___
 Syringe Pump
$2,000.00
___
 Infusion Pump
$2,000.00
___
 Forced Air Warming System
$3,500.00
___
 Cysto Urethro-Fiberscople
$5,600.00
___
 BIPAP
$6,000.00
___
 Defibrillator
$7,000.00
___
 VAC
$7,000.00
___
 Uretero Fiberscope
$8,100.00
___
9465 Wilshire Boulevard, Suite 300
Beverly Hills, CA 90212
310-838-0700
Order for items over $10,000 placed once 50% is received.
 ECG Monitor
$10,000.00
Deposit: $5,000.00
___
 Oxygen Supply at High Flow Rate
$10,000.00
Deposit: $5,000.00
___
 Laryngoscope Adult
$10,000.00
Deposit: $5,000.00
___
 Fetal Monitor
$10,000.00
Deposit: $5,000.00
___
 Bronchoscope
$12,000.00
Deposit: $6,000.00
___
 Glidescope
$14,000.00
Deposit: $7,000.00
___
 Diathermia Valleylab
$14,000.00
Deposit: $7,000.00
___
 Tee Transducer
$30,000.00
Deposit: $15,000.00
___
 Force Triad Energy
$32,000.00
Deposit: $16,000.00
___
 Gastroscope
$40,000.00
Deposit: $20,000.00
___
 Incubator for Premature Infants
$50,000.00
Deposit: $25,000.00
___
 Respirator G5
$55,000.00
Deposit: $27,500.00
___
 Gynecologic Ultrasound
$55,000.00
Deposit: $27,500.00
___
 Mobile XRay Machine
$175,000.00
Deposit: $87,500.00
___
Epiq 5 Ultrasound
$200,000.00
Deposit: $100,000.00
___
Costs are inclusive of all taxes and administrative supply costs. A tax deductible receipt will be sent after the donation is made.
Thank you for saving lives in Israel.
9465 Wilshire Boulevard, Suite 300
Beverly Hills, CA 90212
310-838-0700
Method of payment:
 Check
 Credit Card
 Securities/Stocks
 Cash
Deposit Amount: ______________________________ Date: _________________________________
Balance Due: __________________________________ Date(s): _______________________________
 Payment in full
 Payment in installments: Monthly/Quarterly/Annually
Inscription for Plaques for Gifts Over $5,000:
PRESENTED TO THE PEOPLE OF ISRAEL
IN HONOR OF/IN MEMORY OF
_______________________________________
BY
_______________________________________
[PLEASE PRINT YOUR NAME(s)]
_______________________________________
[CITY, STATE]
_______________________________________
[YEAR]
Publicity preferences
Friends of Sheba Medical Center  may  may not use my/our name(s) for promotion or publicity in press
releases, e-mails, newsletters, or other materials.
Signature
Donor Signature: _______________________________ Date: _________________________________
Donor Signature: _______________________________ Date: _________________________________
Accepted by:
Date:
9465 Wilshire Boulevard, Suite 300
Beverly Hills, CA 90212
310-838-0700