Survey - Register an Event - Lehigh Valley Health Network

Register an Event

Thank you for your interest in hosting a fundraiser to benefit Lehigh Valley Health Network! Please complete the form below, and a member of the Philanthropy team will contact you to support your efforts. Contact Kelly McCready at kelly.mccready@lvhn.org if you have any questions.

1. Field Is Required Primary Contact First & Last Name:

2. Field Is Required Email Address:

3. Field Is Required Phone Number:

4. Company Name: (Maximum response 255 chars, approx. 5 rows of text)

5. Field Is Required Address: (Maximum response 255 chars, approx. 5 rows of text)

6. Field Is Required City: (Maximum response 255 chars, approx. 5 rows of text)

7. Field Is Required State: (Maximum response 255 chars, approx. 5 rows of text)

8. Field Is Required Zip Code: (Maximum response 255 chars, approx. 5 rows of text)

9. Field Is Required Name of Event: (Maximum response 255 chars, approx. 5 rows of text)

10. Field Is Required Start Date:

11. Field Is Required End Date:

12. Field Is Required Type of Fundraiser:

13. Please share more about your fundraiser and the event you plan to host (location, expected attendance, etc.):

14. Field Is Required What is your connection with LVHN?

15. Field Is Required Have you fundraised for LVHN in the past?

16. Questions?