Sponsorship Form
Application date
-
Month
-
Day
Year
Date
Organization Details
Name of the Organization
Contact Person in the Organization
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Sponsorship Request Type
Monthly sponsor
Annual sponsor
Gift-in-kind donation
One time donation
Donation For silent auction
Other goods donation
Sponsorship Packages
*
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( X )
Annual Sponsorship Level
$
1,000.00
Annual Sponsorship Level
$
500.00
Annual Sponsorship Level
$
400.00
Annual Sponsorship Level
$
250.00
Annual Sponsorship Level
$
100.00
Monthly Sponsorship Level
$
50.00
Monthly Sponsorship Level
$
100.00
Monthly Sponsorship Level
$
250.00
Monthly Sponsorship Level
$
400.00
Monthly Sponsorship Level
$
500.00
Monthly Sponsorship Level
$
1,000.00
Total
$
0.00
Authorized Signature
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