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Charity / Donation Requests
Submit all requests for participation in a local event, charitable donation, or advertisement request.
Make sure all requests are pre-approved by your ROD and this form is completed in its entirety before submitting.
Once submitted, Marketing will reach out to you to review and follow up on any details needed. When your project is approved by marketing, submit a check request to
AP@exerurgentcare.com
and CC:
lisa.overman@exerurgentcare.com
. Examples for this type of request would be school event participation outside of ES&S, booth at a community event, raffle prize, etc.
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* Indicates required question
Has this request been approved by your ROD?
*
Yes
No
N/A
If so, what is your ROD's name?
Your answer
Exer Employee's Name:
*
Your answer
Requester's Name
*
Your answer
Requester's Email Address
*
Your answer
Clinic Location(s):
*
Your answer
Benefitting Organization / Advertiser (For ES&S use separate form located in the Marketing Dashboard):
*
Your answer
Check Requested Amount (Upon approval for this project, send your check request form to AP@Exerurgentcare.com.):
*
Your answer
What type collateral?:
*
Digital (i.e. website, social post, etc)
Print (i.e. flyer, banner, etc)
Other:
Art File Specifications (
Please include dimensions and file type needed):
*
Your answer
Your personal recommendation on why we should sponsor: (with your local knowledge):
*
Your answer
Deadline date to receive the art files (Please allow 10 business days):
*
MM
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