180 Parkwood Drive
Elkin, NC 28621
336-527-7000
Contact Us
Current Employees
180 Parkwood Drive, Elkin, NC 28621 | 336-527-7000
Contact Us
|
Current Employees
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& Resources
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& Patient Portal
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Credentialing
Home
About Us
+
Accreditation
Awards
Comments and Suggestions
Community Health Needs Assessment
Community Links
Foundation
• Board of Directors
• Volunteers
○ Junior Volunteers
○ Junior Volunteer Application
○ Membership Application
• Foundation Events
• How to Give
• Planned Giving
• Grants
Hablamos Español
Hospital News
• Media Contact
Mission and Vision
Publications
Quality Management
Sponsorship & Speaker Requests
Patients & Visitors
+
Patients
• Advance Directives
• Billing Information
• Financial Assistance
• Find a Physician
• Medical Records
• Online Bill Pay
• Patient Rights and Responsibilities
• Religious Support
• Your Hospital Stay
• Report a Compliance Issue
Visitors
• Building Map
• Campus Map
• Cafe Menu
• Gift Shop
• Hotels
• Weather Delays/Closings
• Report a Compliance Issue
Services
Education & Resources
+
Calendar
Wellness Center calendar
Careers
+
Employment
Nurse Recruitment
Physician Recruitment
Student Internships
Online Bill Pay & Patient Portal
Medical Staff Credentialing
About us
Accreditation
Awards
Comments and Suggestions
Community Health Needs Assessment
Community Links
Foundation
Foundation Overview
Board of Directors
Volunteers
Junior Volunteers
Junior Volunteer Application
Membership Application
Foundation Events
How to Give
Planned Giving
Grants
Hablamos Español
Hospital News
Hospital News
Media Contact
Mission and Vision
Publications
Sponsorship & Speaker Requests
Learn More
Find a physician
View our calendar
About Us
Speakers Bureau Request
Name of requesting organization
Tax ID number (if known)
Contact full name
Phone
Secondary Phone
Contact email
Organization street address
City
State
Please select
North Carolina
Virginia
Zip
Organization website
Event name
Event date (Must be a minimum of 6 weeks from date of submission)
Location of event
Start time
End time
Is this a first year event?
Yes
No
Number of years event has been in operation
Expected attendance (Number of attendees/participants)
What topics are of interest to your organization?
Behavioral and mental health
Cancer
Diabetes
Family medicine
Heart health
Lung health (pulmonology)
Nutrition and wellness
Neuroscience (brain and spine) and stroke
Orthopedics and sports medicine
Women's health
Other
Please list what audio visual capabilities will be available,
if needed (computer, VCR, microphone, projector and screen)
Will there be table space for handouts?
Yes
No
List other dates under consideration
Other information we should know or consider related to this request
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