POL CARE SPONSORSHIP FORM

POL CARE SPONSORSHIP FORM
We are grateful to the community partners whose substantial support makes our mission possible.

Your monthly support and contributions will enable us to meet our goals and improve conditions. Your generous donation will fund our mission.

Thank You For Your Support
BECOME A LOVE, SILVER, SAPPHIRE, OR PLATINUM PARTNER
DONATION AMOUNT*
prevnext( X )
LOVE SPONSORHIP$25.00

SILVER SPONSORSHIP$50.00

SAPPHIRE SPONSORSHIP$100.00

PLATINUM SPONSORSHIP$500.00

Total $0.00
Company/Org POC Name

First NameLast Name
Company/Org Name
Company/Org Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company/Org Phone Number

Area CodePhone Number
POC E-mail
Should be Empty: