Sponsorship Request Form

Please complete the form below and click "submit form" when finished.

Organizations may be asked to provide additional information.

Organizational Information 

 
Name of Requesting Organization
Street Address  
City
State
Zip Code
Contact Name
Contact Phone
Contact Fax
Contact E-mail
Organization Website
General Nature of Services
Provided by Organization
 
Geographic Area Serviced  
Tax Exempt Status
Tax ID Number

Board Members
(Please separate the name of each board member with a semicolon. Example: John Smith, MD, Chair; Jane Doe...)

 

 

Event / Project Information 

 
Name of Event / Project
Event Website
Brief Description of Event  
Location of Event
Date of Event  [None] Select a Date Delete the Date

 

Demographics

 
How many people will be affected by event directly?
How many people will be affected by event indirectly?
Economic Status of Population Served
Amount Requested
(Example: $100.00)
Percentage of funds raised that will go directly to the publicized charitable purpose rather than for overhead, administrative cost or ancillary activities.
List Other Sponsorship Levels  
Includes the following sponsorship recognition  
   
   

 

Please click the submit button only once.
It may take up to a minute for the results to come through.

Quick Reference

Important Numbers

Main 336-716-2011
Patient Info 336-713-0000
Media 336-716-4587
Jobs 336-716-4717

Ways to Give
USNWR 2013-2014Magnet Hospital RecognitionConsumer Choice2014 Best DoctorsJoint Commission Report

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.