Sponsorship and Donation

Request Form

To request a Sponsorship or Donation, please complete all fields and provide required documentation.


  • Be prepared to complete the form in its entirety, forms cannot be saved.
  • Requests must be submitted at least sixty (60) business days prior to the program start date.
  • Requests are reviewed monthly, and decisions are communicated via email to the contact provided on this form.
  • Any personal information collected in this form or sent to sponsorships@akebia.com will be used solely to respond to your request. Please see the Akebia Privacy Policy for more information.
  • Be sure to review your request carefully before submitting, missing or incorrect information may result in a delay or rejection of this request.


For questions, please contact sponsorships@akebia.com.

 
 

Requesting Organization Information

 
 
 
 
 
 
 
 
 
 
Phone
 
 
 
 

Organization Representative

 
 
 
 
 
Phone
 
 
 
 

Event Information

 
 
 
 
mm/dd/yyyy
 
 
mm/dd/yyyy
 
 

(in US dollars)

 
 
 
 

Indicate the tangible commercial benefit(s) that Akebia will receive as a benefit of this funding.

 
 

If the benefit includes membership in an organization, list the specific benefits of membership:

 
 
 
 
 

The following documents are required to submit a sponsorship or donation request:


  • Documentation from the Organization describing the activity (e.g. brochure, formal letter/invitation, agenda, conference schedule)
  • Organizations W9 (and or international equivalent)
  • If the Organization is tax-except as defined by the tax authority, e.g., IRS (IRS determination letter, Form 990, or other government issued tax documentation)
Drop your files here
 
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