Alliance Health Sponsorship Request Form
Organization information
Organization name
*
Contact name:
*
Physical address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone
*
Format: (000) 000-0000.
Website
*
Employer Identification Number (EIN) or non-profit tax ID number:
*
Event details
Event title
*
Event date (mm/dd/yyyy)
*
-
Month
-
Day
Year
Date
Start time (hh:mm)
*
Hour Minutes
AM
PM
AM/PM Option
Event date (mm/dd/yyyy)
*
-
Month
-
Day
Year
Date
End time (hh:mm)
*
Hour Minutes
AM
PM
AM/PM Option
Venue/event location
*
County of event
*
Target audience
*
Projected attendance
*
Brief description/purpose of event:
*
Funding request
Amount of funding requested
*
What are the sponsorship levels available and/or any marketing/promotional opportunities for Alliance Health associated with this event?
*
Alliance Health involvement
Are you requesting Alliance Health staff to set up a resource table at this event?
*
Yes
No
If yes, please describe:
*
Has Alliance Health sponsored any events for your organization in the past?
*
Yes
No
When is the deadline for when funds are needed?
*
-
Month
-
Day
Year
Date
Supporting documents
You may upload any paperwork that Alliance Health needs to fill out related to this sponsorship request. You may also attach other accompanying documents (event brochures, agendas, flyers) related to this sponsorship request.
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