External Embed

*Event Date

*501(c)(3) Tax ID number

*Attach a PDF of 501(c)(3) letter. This must be included to be considered for a donation

NOTE: Please meet the following criteria:

File type: .pdf / .txt.
Max file size: 20MB

*Attach a PDF of 501(c)(3) letter. This must be included to be considered for a donation

Organization Information

*Organization Name

*Organization Website

*Mailing Address

*City

*State

*Zip Code

*Mission Statement (50 word limit)

*Has your organization received a donation from MMC in the past?

Yes

No

*Please specify the dates and the amounts received

*If no, please upload your W9 for consideration

NOTE: Please meet the following criteria:

File type: .pdf / .txt.
Max file size: 20MB

*If no, please upload your W9 for consideration

*Has your organization requested sponsorship from our Corporate Office or any other hospitals within our system?

Yes

No

*Please specify which entities and for how much

Event Information / Donation Request

*Event Name

*Years Hosting this Event

*Estimated Attendees

*Virtual

*Event Location

*Event Address

*City

*State

*Zip Code

Donation Information

*Event Description (100 word limit)

*Describe the Specific Donation Request (100 word limit)

Does your organization provide tables, chairs and tent coverage (if outdoor event) for sponsorship levels that include a tabling opportunity? Please check all that apply:

*Table

Yes

No

*Chairs

Yes

No

*Tent

Yes

No

*Sponsorship Levels / Additional Information

*Ad Size and Format

*Ad Color

*Ad Deadline

Donation Request Contact

Please note that donation checks will be mailed to the contact's attention at the organization's main address unless other directions are provided.

*Title

*First Name

*Last Name

*Email Address

*Phone Number

*Confirm Security Question below:

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