Application for PeaceHealth Sponsorship - Alaska
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 3100 Tongass Avenue, Ketchikan, AK, 99901, or fax at 907-228-8581. To email materials or ask questions, contact Mischa Chernick at MChernick@peacehealth.org, 907-228-8300 ext 7176.
Fill in the information below. Use the scroll bar on the right to move down the page. When finished, click the
button located at the bottom of the form.
Date of request:
Name of organization:
Best contact person:
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?