Donation & Sponsorship Request
Please review our guidelines regarding what we do and do not fund. This list can be found at: https://www.lchcia.com/for-visitors/donations-sponsorship-requests/
Basic Information
Contact Person:
*
First Name
Last Name
Organization:
*
Phone #:
*
Please enter a valid phone number.
Email:
*
example@example.com
Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Details:
What is your type of request?
*
Please Select
Financial support (donation/sponsorship)
First Aid Kit donation
Donation of promotional materials (pens, etc)
If requesting a donation/sponsorship, what is the date you need the check? (Please allow at least 2 weeks for processing.)
*
-
Month
-
Day
Year
Date
Please provide a brief description of what you are requesting. (What donation amount, what items in particular, what funds will be used for, etc.)
*
Will you need a copy of LCHC's logo? (To include on flyers, brochures, etc.)
*
Please Select
Yes
No
If you have a flyer or letter to share, please upload it here.
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