Sponsorship Request

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Sponsorship Request

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*Before submitting request, please review guidelines.
  
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Event/Sponsorship:
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Name of Organization:
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Organization's Address:
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Requestors Name(s):
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Requestor's Mailing Address:
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Requestor's Phone Number:
Requestor's Email Address:
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Amount or in-kind contribution request:
If available, what are the sponsorship levels and associated benefits:
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Number of people expected to be reached:
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Timeline/Deadline for decision:
(funds must be requested at least 30 days prior to need)
501c (3) number:
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Are you a not-for-profit organization?
If yes, provide a copy of your not-for-profit status determination letter.
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Has this group or organization requested any other funding from the Memorial Health System this year?
If yes, provide details:
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Was this request made last year?
If yes, how much was requested?
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Parameters for involvement (i.e., day-of-event involvement, giveaways provided at event, other related needs):
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Briefly describe the sponsorship or in-kind donation - how it supports the priorities identified in the sponsorship guidelines, etc.
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Describe how funds will be spent:
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How does this request promote health care?
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Limited funds are available for sponsorship requests, so please tell the committee why your request should be considered over the numerous other requests received?
Security Code
Type Security Code

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(740) 374-1400
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