Sponsorship

All fields with an asterisk (*) are required.

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2022-CAP-Portsmouth Regional Hospital-Sponsorship and Donation Application-PI

Please provide an introductory statement outlining the nature of the request and sponsorship goals*

Organization Legal Name*

Mission Statement*

Submission Date of Request

Specifics of the Request (where, when, benefiting whom, etc.)*

Sponsorship Benefits (signage, shirts, program, social media, etc.) *

Deadlines (for copy, ads, etc.)

Name*

First Name

Last Name

Contact Title*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Contact Email*

Contact Phone Number*