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Donation Request

Sponsorship/Donation request from Florida Hospital Zephyrhills

Florida Hospital Zephyrhills is committed to the investment and support of our community and surrounding communities.

We welcome your requests, but ask the following:

Please make your request at least 8 weeks prior to your event or sponsorship deadline.
Completion of this form does not guarantee acceptance by Florida Hospital Zephyrhills.
We are unable to accommodate requests for individuals, for-profits, and out-of-area organizations.

Organization Name:*
Contact Person:*
Contact Person's Phone Number:*
Organization's Street Address:*
Organization's City:*
Organization's State:*
Organization's Zip Code:*


Email Address:
Is this a 501(c)(3) non-profit agency?*
Organization's Tax ID Number:
Event Name:*
Event Location:*
Event Date & Time:*
Purpose of Event
Number of people attending:*
What are you requesting?	Sponsorship (list amount in next question) Silent Auction Item Door Prize Food Donation Goodie Bag Item Advertising Banner/Signage Other (explain in "Additional Information" section)
If requesting a "Sponsorship" donation, what is the dollar amount?
Additional Information (if needed):
Has FHZ donated to your group before? If so, when & how much?
What other medical facility is a sponsor?
Submit
* Required