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Sponsorship Request

Midwest Orthopedic Specialty Hospital accepts requests from organizations for support of various charitable activities, events and sponsorships. A team meets monthly to review all requests and determine which best fit our focus of encouraging individuals to improve their overall health and wellness.

To submit a request, please complete our online request form below. We will get back to you within 30 days after submission regarding the status of your request.

If you have questions or require more information about our sponsorship program, please email us at webmaster@mymosh.com and we’ll be in touch.

Thank you!

Your Information
Name*
First Last
Job Title
Phone*
Email*
Organization Information
Organization Name*
Website*
Is your organization a valid IRS 501(c)(3) organization?
- Yes
- No
Executive Director's Name
First Last
Address*
Street Address Address Line 2 City State ZIP
Please describe what type of service your organization provides.*
0 of 500 max characters
How many people do you serve annually?*
If there is a Midwest Orthopedic Specialty Hospital physician or associate who is familiar with your request/event, please note his/her name here.
Program / Event Information
What is the name of the program or event you are asking us to support?*
What is the date of the event/program?
MM slash DD slash YYYY
Are print, digital, or other advertising opportunities available to sponsors?*
- Yes
- No
Please indicate all levels of sponsorship that are available along with the dollar amount. Please provide enough of a description so we understand the difference between levels.*
0 of 1000 max characters
Are there other benefits included with this sponsorship?*
- Yes
- No
Please include any additional comments in support of your request.
0 of 500 max characters
By what date do you need a decision regarding sponsorship?*
MM slash DD slash YYYY
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Sponsorship Request

Your Information

Organization Information

Program / Event Information