Brian’s Cause

October 18, 2025
5:00 pm
Rushville Elks

Benefiting the Rush Memorial Hospital Foundation
Brian’s Cause Cancer Treatment Relief Fund
Presenting Sponsor: INTAT Precision, Inc.

Please Note: Survivors will receive their free shirt at the actual Brian’s Cause event on October 18th.

Cancer Survivor Registration Form

Registration Online

(One Form per Person)

Name:(Required)

First Last

Department at RMH:

Address:(Required)

Street Address Address Line 2 City State ZIP Code

Email:(Required)

Phone:(Required)

I would like to order:(Required)

Long Sleeved T-Shirt (Youth Medium - Adult XL Sizes) - $30/each

Long Sleeved T-Shirt (Adult 2XL & Larger Sizes) - $35/each

Sweatshirt (Youth Medium - Adult XL Sizes) - $35/each

Sweatshirt (Adult 2XL & Larger Sizes) - $40/each

Chicken Dinner - $15/each

Check All That Apply

Brian's Cause Long Sleeved T-Shirt: (Required)

Price: $30.00

Sizes: Youth Medium - Adult XL

Enter Quantity for Each Long Sleeved T-Shirt Size:(Required)

Youth Medium

Youth Large

Small

Medium

Large

Brian's Cause Long Sleeved T-Shirt - Larger Sizes: (Required)

Price: $35.00

Enter Quantity for Each Long Sleeved T-Shirt Size:(Required)

2XL

3XL

Brian's Cause Sweatshirt: (Required)

Price: $35.00

Enter Quantity for Each Sweatshirt Size:(Required)

Youth Medium

Youth Large

Small

Medium

Large

Brian's Cause Sweatshirt - Larger Sizes: (Required)

Price: $40.00

Enter Quantity for Each Sweatshirt Size:(Required)

2XL

3XL

Chicken Dinner Info

Date & Time: October 18th from 5:30-7:30 pm
Location: Rushville Elks Club (223 E. 3rd St.)
Options: Dine In, Carry Out, or Drive-Through
Cost: $15 per meal
Dinner Includes: 3-Piece Chicken (Mixed), Mashed Potatoes, Gravy, Green Beans, Slaw, Roll, & Dessert

Chicken Dinner Tickets

Price: $15.00

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Events

Registration Online

Chicken Dinner Info

Details

Venue

Thank You to Our Sponsors

Brian's Cause