Request for Sponsorship

Organization name *

Organization address *

Contact name *

Contact phone number

Contact email address

Tax ID for non-profit organization

Select which objective your request meets

a. Promotes health education and/or wellness

b. Improves the quality of life in the communities we serve

c. Other(Describe)

Describe the primary objective of the organization event or project

For event sponsorships, please provide event details, incuding name, type of event, date, location and any other additional information

For event sponsorships, indicate whether alcohol or tobacco is a key part of the event

Requested donation from Lima Memorial

Describe the various levels of sponsorship and associated benefits for each, as applicable

Describe who will benefit from the donation

Expected audience, including size

Describe the publicity plan for the event

Estimated expenses as a percent of receipts

List other healthcare participants, if any

List other major sponsors and contributors

Include any additional information you wish to share

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