file

Sponsorship Application

Request for Support

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Name of the organization requesting support
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Name of program or event that support is being requested for
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Measurable Outcomes

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 Tickets to event
 Speaking role
 Sales presence/table at event
 Healthy Zone Cruiser opportunity
 Media/Newsletter
 Logo/name recognition in promotional materials
 Other
 
 
 

Organization Information

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Name of the person who should be contacted about this request
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Phone number of person who should be contacted about this request
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Email address of the person who should be contacted about this request
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If yes, please provide information about the previously sponsored program/event:

 
 
 
 
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Name of the president or executive director of the organization requesting support
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Street address of the location of the organization requesting support
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Tax ID of the organization requesting support
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Name of the city that the organization requesting support is located in
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5-digit zip code of the location of the organization requesting support
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 Albany
 Clinton
 Columbia
 Essex
 Fulton
 Greene
 Montgomery
 Rensselaer
 Saratoga
 Schenectady
 Schoharie
 Warren
 Washington
 

Authorization

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 I certify that all information is correct and that I am authorized to submit this application