Sponsorship Request Form

Please complete the form below and click "submit form" when finished.
Note: All fields are required.

Organizations may be asked to provide additional information.*  

Organizational Information
Name of Requesting Organization
Street Address
City
State
Zip Code
Contact Name
Contact Phone
Contact Fax
Contact E-mail
General Nature of Services Provided by Organization
Geographic Area Served
Tax Exempt Status
Tax ID Number
Board Members
Event / Project Information
Name of Event / Project
Brief Description of Event
Location of Event
Date of Event	Monday, July 01, 2013
Amount Requested
Demographics
How many people will be affected by event directly?
How many people will be affected by event indirectly?
Percentage of funds raised that will go directly to the publicized charitable purpose rather than for overhead, administrative cost or ancillary activities
List sponsorship levels
Sponsorship Recognition Included