Request for Baptist Health Participation

Thank you for considering Baptist Health to participate in your event! Please complete the form below to make us aware of your needs. Please note that submission of this request does not guarantee Baptist Health's involvement in your event and is solely based upon staff availability and focus areas of our programs.  A member of the Department of Social Responsibility will contact you to confirm availability of staff and/or resources.

Please submit request at least 60 days prior to your event.

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* 1. Organization Name

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* 2. Name of Event

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* 3. Purpose of Event

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* 4. Event START Date and Time

Date
Time

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* 5. Event END Date and Time

Date
Time

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* 6. Street Address of Event Location

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* 7. Include name of building, if applicable

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* 8. City of Event Location

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* 9. Zip Code of Event Location

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* 10. Please choose from list of offerings below. Select all that apply.

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* 11. Anticipated Number of Attendees

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* 12. Is the event indoors or outdoors?

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* 13. Will tables and chairs be provided?

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* 14. Contact Name (FIRST and LAST)

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* 15. Contact Email Address

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* 16. Contact Phone Number (XXX-XXX-XXXX)

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* 17. Event Audience Demographic

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* 18. Predominant Language of Attendees

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* 19. Additional Information:

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