Sponsorship Request Form

Backus Hospital provides priority consideration for sponsorship to requests from organizations that will improve access to health care services and enhance the health of the community.

Complete the form below to request to be considered for sponsorship from Backus Hospital. Applicants will be notified of the status of their application within 30 business days. 

Thank you for your interest and for supporting the needs of our community. 


* = required field

Submit a sponsorship

Contact Information

Additional event details

Please answer yes or no to the following questions below