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Community Partnership Request Form

Please complete the form below.
* Denotes required fields

Request Information

* Are other healthcare providers currently sponsoring this request?
For any information required by Avera, provide the following:
Note: All requests by the organization must be submitted at the same time. Subsequent requests may not receive as much consideration.

Contact Information

(required for consideration)
* Are you an Avera employee?
* Is there an Avera facility in your city?
* Have you already contacted another Avera facility?
* Has Avera donated to your organization in the past two years?
* Is there an Avera employee on your board/organizing committee?
Note: This information will be stored in our records as your primary contact. If this is not the primary contact for the organization's event, please provide a more specific email.

Community Partnership Program

  • Community Partnership Request Form

Live Better. Live Balanced. Avera.

Avera is a health ministry rooted in the Gospel. Our mission is to make a positive impact in the lives and health of persons and communities by providing quality services guided by Christian values.

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