Sponsorship Request: Adventist Health St. Helena
Organization Name
Organization Phone Number
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Area Code
Phone Number
Contact Name
*
First Name
Last Name
Contact Phone Number
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Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tax ID number
*
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What are you requesting?
Funding
Promotional items/giveaways
Room space
Other
Please provide an explanation of your request (funding amount, promotional items, age group/audience, date of room use, other, etc.).
*
Are you requesting sponsorship for an event?
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Yes
No
What date do you need materials by? (Please note: responses take up to 45 days)
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Month
-
Day
Year
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Is this a healthcare or wellness related request?
*
Yes
No
How does your request provide community benefit?
*
What goals will this sponsorship help you accomplish?
*
Tell us how this request meets one of the needs outlined in our Community HealthNeeds Assessment
*
How does this request enhance Adventist Health St. Helena's visibility/impact in our community?
*
Are there any other organizations involved in this sponsorship?
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Yes
No
If so, who?
Has Adventist Health St. Helena ever sponsored or partnered with your organization before?
Yes
No
Please provide any additional information you feel would be relevant to this request
*
Support Documents
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Upload any additional documents that would support your sponsorship request.
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