Providing your location allows us to show you nearby locations and doctors.

Sponsorship Requests

Organization

Address

City / State / Zip

Contact Person

Phone Number

Is this organization designated as not-for-profit by the Internal Revenue Service?

Yes

Nature of Sponsorship

Annual

One-time Fundraising Event

Health fair expo

Lecture

What is the date of the event?

What is the type of contribution requested?

Monetary

Promotional Items

Volunteers

Contribution Amount Requested

Attach document(s)

One file only.
10 MB limit.
Allowed types: pdf doc docx.