New Corporate Funding Application

Instructions

Please fill out the application form below for your Corporate Funding request to be evaluated. Apellis may consider providing support for the following types of Corporate Funding: Sponsorship, Charitable Donation, Patient Advocacy, Corporate & Professional Society Membership.

All requests must be submitted at least 45 days prior to the activity start date. Apellis may contact you if we have additional questions about your request. Please allow four weeks for review and response of a funding decision. Apellis notifies applicants of our decision by email.

Please direct all Corporate Funding questions to Apellis’ corporate funding mailbox: sponsorships_na@apellis.com.

The following information is required for corporate funding application submission:

Event, Benefits, & Price Information:

• Letter of Intent or another document that clearly defines the event (including information such as the agenda, requested amount, expected number of participants, location and venue as well as whether other companies have been invited to support the event, etc.); and

• Prospectus/Brochure or other document that defines the cost of each level of funding and accompanying benefits being offered; and

• Current W9 For-profit or 501 c3 Non-profit; and

• Program budget

Event Name*

Event Start Date*

Event End Date*

Program Type*

Corporate & Professional Society Membership

Donation

Sponsorship

Patient Advocacy

Event Format*

In Person

Virtual

Hybrid

Disease State*

Complement 3 glomerulopathy (C3G)

Geographic Atrophy (GA)

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Other

Therapeutic Area*

Hematology

Nephrology

Ophthalmology

Other

Please specify other disease state:*

Program Description*

Geographic Reach*

US City/State

US National

Global

# Estimated Audience

Audience Description*

Requested Amount*

Conference URL

Venue Location

Organization Name*

Organization Address*

Organization City*

Organization State*

Organization Postal Code*

Type of Institution*

Non Profit

For Profit

Tax ID*

Tax Status*

Key Contact Name*

Key Contact Email*

Key Contact Phone Number*

Phone

Authorized Signatory Name*

Authorized Signatory Title*

Authorized Signatory Email*

Opportunities available to other Companies?*

Select

Funding only for Tangible Benefits?*

Select

CME Events, booths in separate space?

Exhibit booths must be separate from the education space if the event includes CME.

Select

File Upload*

Letter of Intent
Agenda
Prospectus/Brochure
Program Budget
Current W9 For-profit or 501 c3 Non-profit,

Drag and drop files here or

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