Sponsorship and Community Outreach

*Required Fields

Date of application: *

Date response is needed: *

Name or organization: *

Event date: *

Address/location of event: *

City: *

State: *

Zip: *

Target Audience

Expected number of attendees: *

Purpose and goal of event:

Contact Information:

Contact name: *

Title: *

Address: *

City: *

State: *

Zip: *

Phone Number: *

E-mail: *

Type of Request:: *

Sponsorship
Promotional Items
Physician guest speaker

If Sponsorship was chosen above, please provide the Amount here: *

Topic of Interest:

Additional Details:

Has High Point Regional Health System sponsored your organization in the past?

yes
no

If yes:

What Year?

How much $?

Please give a brief description of your organization:

Please explain how the sponsorship/promotional items will be used and how it will benefit people in our community.

Will High Point Regional Health System be recognized for the sponsorship?

yes
no

If yes, please explain how. (invitations, ads, etc.)

Upload a Document: (please zip multiple files)

High Point Regional Health System
P.O. Box HP-5
High Point, NC 27261
336-878-6000
24-hour Emergency Department
336-878-6009