Today's Date *

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?

Event URL

If applicable – for us to review more information.

Estimated Attendance at Your Event *

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Audience at Your Event * Children (0 – 12) Teens (13 – 19) Adults (20 - 64) Seniors (65+)

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Marketing Opportunities for WellSpan * Advertisement Event Attendance Event Table/Promotion Speaking Opportunity Logo Only None of the Above

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Additional Sponsorship Information

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