HRMC Donation or Support Request

Sponsorship/Donation Form

The mission of Huron Regional Medical Center is to improve the wellbeing of individuals in our regional by providing high quality health care. We prioritize community benefit opportunities that align with our mission and events and organizations our employees support through volunteerism.

Please fully complete the form below to be considered for a donation or sponsorship.

1. Today's Date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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2. Your Name *This question is required.

3. Organization or Cause Name
*This question is required.

4. Address *This question is required.

5. Email *This question is required. This question requires a valid email address.

6. Phone *This question is required.

7. Website (if applicable)

8. Event or Charitable Cause

9. Are you an employee of Huron Regional Medical Center or on the HRMC Board of Directors or Medical Staff?

10. Do you volunteer for this organization or event you're requesting HRMC to support?

10. Approximately many hours do you volunteer per year?

10. What is your connection to this charitable cause? Why do you volunteer?

10. What is the reason for donation or sponsorship request? *This question is required.

11. If applicable, what is the purpose/mission of your organization?

12. Donation requested *This question is required.

In-kind donation
Financial contribution

13. What type of in-kind donation are you requesting? Please be specific. Examples: food items, bottled water, etc.

13. Amount of request This question requires a valid number format.

13. Date needed *This question is required.

14. How does this benefit the community? *This question is required.

15. Will HRMC be recognized as a contributer?

16. How will HRMC be recognized?

16. Please list any additional information you'd like to share.

17. Please upload any files or sponsorship forms here.

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