Prevea Sponsorship Request Form
Organization
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Organization Address
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Organization City and Zip Code
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Contact Name
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Contact Phone Number
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Contact E-Mail
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Beneficiary
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Beneficiaries Tax-Exempt 501(c)3 ID
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List the primary county the Benefiary supports
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Select or enter value
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Event Name
Event Date(s)
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Calendar
Event Location
Request amount
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If Prevea has supported this event in the past, please indicate when and what was contributed.
Are other health care organizations supporting the cause? If so, who?
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Date approval deadline for marketing purposes
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Calendar
Please attach information about event and how Prevea will be recognized.
*
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