Sponsorship Request Form
NorthShore Health Centers is committed to collaborating with other organizations in order to improve the overall health of the communities we serve. We realize a healthy person and a healthy community is often dependent on partnering organizations pooling resources to make a larger impact. For this reason, we welcome donation and sponsorship request. Please fill out the form below with as much information as possible about your organization and purpose of the donation. You can also upload documentation highlighting sponsorship levels or details.
Name
*
First Name
Last Name
Company Name or Organization
*
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Sponsorship
Please Select
Donation
Business/Corporation
Event/Golf Outing
Sports/Activity
Other
Sponsorship Amount
Please Select
$100
$250
$500
$1,000
Other
Browse Files
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