Sponsorshipform - BEAR LAKE MEMORIAL

Sponsorship PDF Form

Criteria

Applicants must be a group or organization. No individuals. Please describe the
sponsoring agency (i.e. Parks & Rec, Bear Lake High School, etc.)
Application must be submitted at least three weeks prior to event.
Must be residents of Bear Lake Memorial Hospital's service area.
Itemized description of how money will be used. (Receipts may be required)
If any, list included advertising that the hosptil may receive related to supporting
this event.(banner, logoed shirts, name mentions, etc.)
Supporting statement or endorsement from coach, club director, or secretary how
funding and event will support your goal or benefit the community.

About the Applicant

Name

Phone

Postal Code

Email

State

Address

About your Organization/Club/School

OrganizationClubSchool

SecretaryCoachIndividual

Name

State

Website

Make Check Payable to

Postcode

Telephone

Address

Your Reason for this Application

Please state your reason for this application: (include funding request)

Supporting Statement from Secretary/Coach/Tutor

(This may be made separately in letter form if preferred)

Name

Occupation

Signed

Date

Declaration

The above information is true and accurate
to the best of my knowledge.
Signed

Parent / Guardian signed: (under 18’s )

Date:

This form, together with any other
information you wish to append should be
returned to the address below at least
three week prior to event.

Julie Nelson
Marketing Manager
julie.nelson@blmhospital.com
164 S. 5th St. Montpelier, ID 83254