Community Sponsorship Application

Date:
Your Name:
Phone:
E-mail:
Organization name:
Mailing address of your organization:
Organization’s President/Executive Director:
Organization’s mission:
501(C)(3) organization? (If so, please attach IRS tax status letter)
IRS Tax Status Letter:
Title of your event:
Event date(s):
Please list the names of Via Christi Clinic physicians and employees who currently volunteer for your organization and/or this event:
Have you received funding from Via Christi Clinic in the past five years? If so, how much and when:
Does your organization currently receive funding from UNITED WAY:

Online Prescription Refill

Via Christi Clinic offers urgent care on a walk-in basis to treat minor emergencies.

East Wichita
3311 E. Murdock – (316) 689-9107
Mon – Fri 8 am – 8 pm
Sat 9 am – 6 pm
Sun Noon – 6 pm
Holidays – See Immediate Care page

West Wichita
13213 W. 21st St. N – (316) 946-1789
Mon – Fri 5 pm – 8 pm
Sat 9 am – 5 pm
Sun Noon – 5 pm
Holidays – See Immediate Care page

Newton
700 Medical Center Dr. – (316) 284-5011
Mon – Fri 5 pm – 8 pm
Sat 9 am – 1 pm

Diabetes Education Classes
Via Christi Clinic Diabetes Education Classes are offered on selected days of the week from 8:30 am to 5 pm.

3311 E Murdock, Wichita, KS 67208 — 316-689-9111

Via Christi Clinic is a tobacco-free organization. Smoking and the use of all tobacco products is prohibited inside buildings and on all properties.

Website Developed by Insite Motion