Your Name *

Your Phone *

Your Email *

Date (Deadline) by which you require invoice payment *

Date (Deadline) by which you require artwork *

For consideration, please provide all the following details:

Organization Responsible for Event *

Name of the Event *

Event Date *

Event Address *

City *

State *

Zip code *

Dollars requested *

One number only – no ranges. If multiple opportunities are available please include those in the additional information field.

Goal of Your Event *

Why are you holding this event? (2500 character limit)

2500

Event URL

If applicable – for us to review more information.

Estimated Attendance at Your Event *

One number only – no ranges.

Audience at Your Event *

Select all that apply

Marketing Opportunities for WellSpan *

Select all that apply

Additional Sponsorship Information

Maximum File Upload Size: 5 MB.
Accepted file types: .txt, .pdf, .doc, and .docx.

File Upload 1 File is too large. Maximum file size is 5 MB.

File Upload 2 File is too large. Maximum file size is 5 MB.

File Upload 3 File is too large. Maximum file size is 5 MB.

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