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Third-Party Fundraiser Event Application

Please complete and submit the following application at least 3 weeks prior to your event. 

Note: The web form below will not save your content if you exit the page without submitting.
Click HERE to download the printable PDF of the application and guidelines. 

If you prefer, paper application may be completed and mailed to:

MVHPC

Attn: Audrey Cassell

1427 Edgewood Drive

Suite 101

Mount Airy, NC 27030

Dobson
105 North Crutchfield Street
Unit 2
Dobson, NC 27017
Pilot Mountain
129 Veterans Drive
Pilot Mountain, NC 27041
Galax
7599 Carrollton Pike, Ste C
Galax, VA 24381
Elkin
968 North Bridge Street
Elkin, NC 28621
Yadkinville &
SECU Hospice Care Center
243 North Lee Ave.
Yadkinville, NC 27055
Martinsville
240 Commonwealth Blvd West,
Unit 602B
Martinsville, VA 24112
Woltz Hospice Home
945 Zephyr Road
Dobson, NC 27017
King
141 Spruce Pine Way
King, NC 27021
Winston-Salem
3069 Trenwest Drive
Winston-Salem, NC 27103
The Humble Hare
705 W Pine St, Suite 300
Mount Airy, NC 27030
The Humble Hare
38 E Cheek St
Sparta, NC 28675
Kernersville
220 Market View Drive, Ste C
Kernersville, NC 27284

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Mountain Valley Hospice and Palliative Care BBB Business Review
Mountie Award and Hospice Honors winner in 2022 and 2023