Sponsorship Request Form

Please complete this form and submit at least three months before sponsorship opportunity is occurring. Please note that Reliant Medical Group generally will only consider one proposal per organization in each calendar year. Sponsorship proposals will not be considered unless this form is fully completed. Thank you.
Name of Your Organization * Required
Briefly describe your organization, including primary mission and audience served * Required
Is this Organization a 501c3 nonprofit? * Required
- Yes
- No
Name of Event and Description * Required
Date of Event * Required
Month
Day
Year
Location of Event * Required
Where will this event occur (name town and venue)? * Required
Number of Attendees Expected * Required
Please enter a number from 1 to 20000.
Sponsorship Levels & Benefits (please include multiple levels) * Required
Specifically, how will the proceeds of this event be used? * Required
Contact Name * Required
First Last
Title
Address
Street Address Address Line 2 City State ZIP Code
Email * Required
Phone * Required
Notes/Deadlines

Am I eligible to use Virtual ReadyMED?