Thank You for Your Interest in Hosting an
Event for the Suncoast Hospice Foundation

We ask that you complete the Community Events form below and submit for our review. The information provided will allow us to review the details of your event and approve the use of the Suncoast Hospice Foundation | Empath Health name and trademarks. Requests are reviewed on a monthly basis and must be received no later than 60 days in advance of the event. Empath Health reserves the right to refuse the use of the logo and/or name.

Company/Organization*
Name
Contact Person*
First Last
Contact Phone*
Secondary Phone
Contact Email*
Contact Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Event Name*
Event Date*
MM slash DD slash YYYY
Event Time*

: Hours

Minutes

AM/PM
Event Location*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Who will be your primary target audience?*
What percentage of the proceeds will be donated?*
Select Empath Health member you would like to support.*
If Suncoast Hospice Foundation is your choice, funds will be distributed where it is needed most.
- Suncoast Hospice Foundation
- Suncoast Hospice
- Suncoast PACE
- EPIC (Empath Partners in Care)
Please share any other pertinent information about your event.
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Phone
This field is for validation purposes and should be left unchanged.

GFWC North Pinellas Woman’s Club presents
Empath Health with a $1,000 community grant
benefiting our volunteer sewing program that
makesitems for our Empath Health patients and
Suncoast PACE participants..

Thank You for Your Interest in Hosting an Event for the Suncoast Hospice Foundation

Thank You for Your Interest in Hosting an
Event for the Suncoast Hospice Foundation