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Application for PeaceHealth Sponsorship - Oregon
Form Description
We ask that all groups and organizations seeking PeaceHealth's financial or in-kind sponsorship complete and submit this application. You're welcome to send supplementary materials to Marketing/Communications by mail at P.O. Box 1479, Eugene, OR, 97440, or fax at 541-687-4986. To email materials or ask questions, contact Emily Dixon at EDixon@peacehealth.org, 541-686-7110.
Directions
Fill in the information below. Use the scroll bar on the right to move down the page. When finished, click the
Submit
button located at the bottom of the form.
Date of request:
Name of organization:
Mailing address:
Best contact person:
Phone number:
Format: (999)999-9999
E-mail address:
Short description of the organization or group and its mission:
Geographic area served (i.e., Lane County, city of Eugene):
Name of event/activity:
Date of event/activity:
Location of event/activity:
Approximate number of people served or involved in event/activity:
Would the sponsorship include a table at the event, or PeaceHealth participation in some other form? If yes, please give details.
Describe how this event/activity ties in with improving personal and/or community health and wellness:
How will you measure its success?
Requested dollar amount/in-kind support:
Date by which funds/services are requested:
How would the sponsorship be acknowledged?
