Reata Pharmaceuticals Inc. - Sponsorship Request Form

Before completing this sponsorship request form, please make sure you have read and understand the requirements for submitting an application and the types of programs that may be considered for funding.

1. Organization Requesting Sponsorship *

2. Contact Information

First Name*

Last Name*

Email*

Phone Number*

4. Amount Requested *

3. Sponsorship Utilization

Program/Event Title*

Program/Event Date(s)

Program/Event Location/Venue *

Program/Event Description *

Please attach the following required documentation *

Attach additional supporting documentation if appropriate: 

Letter of Request
Activity agenda and description of the program
Sponsorship brochure or other documents listing prices and tangible benefits
Sponsorship tiers
IRS documentation (e.g., IRS nonprofit determination letter, W-9 form)

File Upload

4. Additional Program/Event/Congress Information (if not applicable, continue to 5)

Anticipated Attendance (i.e., Specialists, Nurses, Coordinators, etc.)

Number of Attendees

Other Grantors/Potential Grantors

Corporate Sponsorship Opportunities

Exhibit opportunity?

YesNo

If yes, describe type of exhibit and additional cost, if any:

5. Requested Decision Date, if any *

Please allow a minimum of 60 business days

6. Acknowledgements and Signature

Reata is committed to compliance with all applicable federal and state pharmaceutical industry laws, regulations and guidelines. By submitting this application, Requestor represents their commitment to act in accordance with the above in the event that the request is approved.
Submission of this Request Form and supporting documentation does not constitute nor represent a funding commitment by Reata. Funding decision is subject to approval by Reata’s internal review committee, which may approve or decline a request in its sole and absolute discretion. If, for any reason, the program or event does not occur, or the awarded funds prove to be in excess of the estimated program costs, the unused portion be returned to Reata. Reata will not provide supplemental funding retrospectively to cover program expense overages.
Requestor represents and warrants that this request is unrelated to the future purchase, use or recommendation of Reata products. In addition, Requestor acknowledges that their organization will maintain control over the program/event at all times and that Reata may not influence the content, or selection of speakers, attendees, or individual recipients of fellowships or scholarships, where applicable.
I hereby further certify that the information provided in this request form is complete and correct, and that I have the authority to submit this request on behalf of the organization requesting support.

e - Signature *

Date*

Title *

This completed Sponsorships Request Form and required documentation will be sent to Grants@ReataPharma.com. This form is intended for U.S. use only.