Please fill out the form below to apply for a sponsorship.
The fields marked with an * are mandatory.
Name of Organization *
Event Name *
Type of Event (health fair, donation drive, etc.) *
Event Date *
Event Times *
Event Location (include city, state, zip) *
Number of People Expected to Attend Event *
Event Demographics *
Event Contact Name and Title *
Event Contact Email *
Event Coordinator Phone Number *
Has HopeHealth participated in this event before? If so, when? *
HopeHealth offers the following services at community events. While we will make every effort to accommodate your requests, please note that HopeHealth cannot provde all services at one event. Please check all services requested. *
If 'other' was selected in the previous question, please specify needs here
In 50 words or less, please summarize your event here. *
* This is a printer friendly version of the original page, made to save you ink and paper.
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