St. Mary'S Health Care System Sponsorship/donation Request Form

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St.   M ary’s   H ealth   C are   S ystem   S ponsorship/Donation   R equest   F orm  
*Please   n ote   t hat   y our   r equest   i s   o nly   e ligible   i f   y our   o rganization   i s   N ON-­‐PROFIT  
Date   o f   R equest:  
 
Organization   N ame:  
 
Mailing   A ddress:  
 
Name   o f   R equester:    
 
Business   P hone/Cell   P hone:  
 
Email   A ddress:  
 
Organization   T ax   S tatus/EIN:  
 
Type   o f   R equest     ( see  
S t.   M ary’s   H ealth   C are   S ystem’s   S ponsorship/Donation   P olicy)  
 
 
Charitable   D onation               S ponsorship             E vent   S upport  
 
Name   o f   E vent   o r   S ponsorship:  
 
Amount   r equested:  
 
Previous   s ponsorship/donation   a warded   f rom   S t.   M ary’s   H ealth   C are   S ystem?       Y es           N o  
 
If   a nswer   i s   y es,   p lease   p rovide   a   d ate/event   a nd   a mount   a warded:  
Does   s ponsorship   i nclude   a   p rogram   a dvertisement?         Y es     N o    
 
If   a nswer   i s   y es,   w hen   i s   p rogram   a dvertisement   d ue?  
Timeline/Deadline   f or   d ecision:  
 
(Sponsorship   f orm   a nd   s upporting   d ocumentation   m ust   b e   r eceived   a   m inimum   o f   9 0   d ays  
prior   t o   e vent)  
 

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