SPONSORSHIP CONTRIBUTION REQUEST FORM

Thank you for your interest in Frankfort Regional Medical Center. Our goal is to continue to be an integral part of the communities we serve by contributing to organizations that advance a public purpose of health/wellness, safety, culture and general welfare of our community. Priority will be given to health organizations that are aligned with our Sponsorship Contribution Policy and Criteria focusing on health and wellness.

If you are interested in having Frankfort Regional Medical sponsor your organization or event, you must submit your request by December 31, 2009.

At that time, our Sponsorship Committee will determine our sponsorship commitments for the entire year.  Notices will be sent to all requesting organizations in January 2010. Any requests received after December 31, 2009 will be returned and the organization will be encouraged to apply the following year.

Please include any additional pertinent information along with this form upon submission. 

For questions please contact:
Diane Dominick
Frankfort Regional Medical Center
299 King's Daughters Drive
Frankfort, Kentucky 40601
Phone: (502) 226-7892

Please Note: If the request is accepted, you must complete an Annual Acknowledgement of Gifts form that will be sent to you in order to receive our donation.

Date of request: *  

Email Address:*

Name of event/project to be sponsored:*

Event/Project Date:      *

Event/Project Time:      *

Event/Project Location: *

Description and purpose of organization/project:*

How will the community benefit from this Event/Project?*

Amount of contribution requested:*

Purpose of contribution:* 

What is the deadline for sponsorsing your event?*