Community Benefit Sponsorship Request
Name of Applicant
*
First Name
Last Name
Organization Name:
*
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Organization Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Describe your sponsorship request:
*
Requested sponsorships amount:
*
Event Date (If applicable)
-
Month
-
Day
Year
Date
Sponsorship response need by (date)
*
-
Month
-
Day
Year
Date
Sponsorship type:
*
One-time funding request
Annual Sponsorship
In kind donation
Have you received a sponsorship from Adventist Health in the past?
*
Yes
No
Is this sponsorship request for an event that includes event tickets?
*
Yes
No
Please upload a completed W-9, any event fliers and/or sponsorship request documents
*
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