Parking Decal Request

Memorial Health is committed to providing adequate parking for our patients, visitors, physicians, Mercer affiliates and team members. To help facilitate proper parking distribution it is Memorial's policy that physicians, Mercer affiliates and team members display a Memorial parking decal.

The decal shall be placed on the rear window on the lower left hand corner.

First Name:
Last Name:
Team Member ID Number:
Department Name:
Team Leader's Name:
Vehicle Year:
Vehicle Make and Model:
Vehicle Color:
Vehicle Tag Number:
State in which Vehicle is Licensed:  

I have read and understand Memorial's parking policy (EC-1003)
I further understand by not displaying the decal on my vehicle I shall be subject to corrective action.

By clicking below to submit this form , I acknowledge receipt of the above notices.

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