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Event Request

Thank you for contacting Memorial Healthcare System to participate in your upcoming event. Please complete the form below 6-8 weeks prior to your event and your request will be submitted to the Community Relations Department for review. Each request is carefully assessed to determine if it meets our marketing and community objectives.

For questions please contact Jennifer Belyeu, Manager of Community Relations, at 954-265-0991 or jbelyeu@mhs.net.

  • Required
  • Required
  • Required
  • Behavioral Health
    Bladder Health Information
    Blood Pressure Screening
    Bone Density Screening
    Breast Cancer Center
    CAB's of CPR (not a certification class)
    Cancer Institute
    Cardiac and Vascular Institute
    Child ID (Memorial Medical Child Identification Program)
    Cholesterol Screening
    Diabetes Center
    Family Birthplace
    Fitness Centers
    General Child Safety
    General Speakers Bureau Information
    Home Alone, Safe Alone
    Home Health Services
    Joe DiMaggio Children's Hospital Information
    Mammo Van
    MCVI HealthFair Van†‡
    Memorial Healthcare System Information
    Memorial Hospital Miramar Information
    Memorial Hospital Pembroke Information
    Memorial Hospital West Information
    Memorial Regional Hospital Information
    Memorial Regional Hospital South Information
    Mobile Unit - Adult
    Mobile Unit - Pediatric
    Neuroscience Center
    Pediatric Specialty Services
    Poison Prevention
    Rehabilitation Institute
    Teddy Bear Clinic
    Tour de Broward
    [U18] Sports Medicine
    Weight-Loss Surgery/Bariatric
    Women's Services
    Wound Care

    Fee.       Based on availability.

  • Yes    No
    • Required, eg. 8:00 AM
    • Required, eg. 5:30 PM
  • + Add date
  • Required, eg. 123 Main Street
  • Required, eg. Hollywood
  • Required, eg. 33021
  • Required
  • Yes     No
  • Indoor     Outdoor
  • Yes     No
  • Yes     No
  • Yes     No
  • Yes     No
  • Yes     No
  • Email     Flier     Newspaper/Magazine     Radio     Social Media/Internet     TV
    Other    
  • Yes     No
  • Required, eg. John Smith
  • Required, eg. johnsmith@mycompany.com
  • Required, eg. 954-555-0001
  • eg. 954-555-0002
  • Yes     No
  • Required, eg. My Company
  • Required, eg. 159 Corporate Parkway
  • Required, eg. Hollywood
  • Required, eg. 33021
  • eg. 53
  • .pdf or .jpg, <10 MB

Please fix errors and fill out form completely.