Severe Weather Alert - Updated: 11:30 am, January 17, 2018

Due to rapidly changing weather conditions, all Wake Forest Baptist Health clinics will be closing today (January 17, 2018) at 2 pm, and will reopen tomorrow (January 18, 2018) by 10 am. 
Urgent Care – Clemmons and Urgent Care – Mocksville will be closing today (January 17) at 4 pm, and will reopen tomorrow (January 18) by 10 am.
If you have questions, please contact the clinic directly.

Sponsorship Request Form

Please complete the form below and click "submit form" when finished.
Note: All fields are required.

Organizations may be asked to provide additional information.*  

Organizational Information  
Name of Requesting Organization
Street Address  
Zip Code
Contact Name
Contact Phone
Contact Fax
Contact E-mail
General Nature of Services Provided by Organization  
Geographic Area Served  
Tax Exempt Status
Tax ID Number
Board Members  

Event / Project Information
Name of Event / Project
Brief Description of Event  
Location of Event  
Date of Event  Monday, July 01, 2013 Select a Date Delete the Date
Amount Requested
How many people will be affected by event directly?
How many people will be affected by event indirectly?
Percentage of funds raised that will go directly to the publicized charitable purpose rather than for overhead, administrative cost or ancillary activities
List sponsorship levels    
Sponsorship Recognition Included