Community Event and Sponsorship Request Form

UPMC Western Maryland receives requests for community event and sponsorship contributions each year. While we are dedicated to improving the health and well being of people in the communities we serve, all decisions are based on consistency with the mission statement, vision and core values of UPMC Western Maryland and funding availability.

If you would like UPMC Western Maryland to consider a community event or sponsorship request, please submit the below form accurately. Submissions are received and evaluated on an ongoing basis.

Sponsorship Form

Requestor Information
Contact Name
First Last
Contact Email
Contact Phone
Organization Information
Payee Name and Address
Organization Name
Organization Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
County or Area Served
Website
Facebook Page
Taxpayer ID Number (Example: 123456789)
Tax Exempt Status
Requested Dollar Amount ($)
Event Date / Sponsorship Deadline
Expected Event Attendance
Describe how this event or sponsorship will support the communities served by UPMC Western Maryland.
Describe how the contribution / sponsorship dollars will be used.
Please provide any additional information that may be helpful in reviewing your request.
How would UPMC Western Maryland be promoted as a sponsor? Upload Sponsorship Package/Letter

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Community Event and Sponsorship Request Form

Sponsorship Form

Requestor Information

Organization Information