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Event 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
 Digital Media (website, social media)
 Other
 
 
 

Organization Mission

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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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Mailing address of the location 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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Tax ID of the organization requesting support
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IRS designated tax-exempt number
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 Allegany
 Cattaraugus
 Chautauqua
 Erie
 Genesee
 Niagara
 Orleans
 Wyoming
 

Authorization

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 yes
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Enter the code to the right of the field