Our Network
Home
MyChart
About
Careers
Volunteer
Map & Directions
Make an Appointment
Schedule a Mammogram
Menu
Find a Physician
Services
Patients & Visitors
Our Location
Classes & Events
News
Contact
Home
/ Sponsorship Application
Sponsorship Application
Name of Requesting Organization
*
Name of Event
*
Date of Event
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2023
2024
2025
Tell Us about Your Organization/Event
*
Your organization’s mission, projected attendance, demographics, how long you have been doing this event, goals for event, does this improve or impact health care in our region, benefits of the event for our region.
Additional Information
*
Please upload supporting materials here.
Files must be less than
2 MB
.
Allowed file types:
txt rtf pdf doc docx
.
Organization website
*
Street address
*
Address Line 2
*
City
*
State
*
Zip code
*
Upload a completed W9 form
*
Files must be less than
2 MB
.
Allowed file types:
gif jpg jpeg png txt rtf pdf doc docx odt
.
CONTACT
Name
*
First Name
Last Name
Phone
*
Contact Email
*
SPONSORSHIP
Sponsorship Request
*
Dollar amount, in-kind, volunteer needs, or giveaway
Current Sponsors
List any other sponsors and their level of sponsorship.
Mountainside Opportunities
*
What opportunities are available for Mountainside to promote its services and capabilities? Please include any opportunities for a Mountainside representative to speak at this event, or tabling activities.
Can you provide event photos
Yes
No
Other...
Can you provide event photos Other...
For some events/activities, Mountainside would like the opportunity to showcase what we sponsor. Are you willing to share event photos that we can use on our social media channels? Photos can be emailed to Marketing@mountainsidehosp.com
Past Partnerships
*
Describe any past relationship or partnership your organization has had with Mountainside.
