Kentucky Sponsorship and Donation Request

Amount Requested:

Organization/event name:

Key Contact:

Address

Street Address

Address Line 2

City

State

Postal / Zip Code

Email

From which Kentucky market are you requesting support?

Phone Number

501(c)3 non-profit:

YesNo

Type of donation/sponsorship requested (check all that apply)

CashIn-kindPromotional items

Provide a brief summary of how this program or organization will enhance the health and well-being of our community

Organization or event information

Organization or event information files

Organization/Event URL (if applicable)

Event Date (if applicable)

Expected attendance (if applicable)

Donation deadline date:

Will Lourdes or Marcum and Wallace receive any goods or services such as advertising, tickets, meals, etc?

YesNo

Ad specs (if applicable)

Size in inches

Color, Black/White:

Submit artwork to:

Artwork due date:

Attachments:

Attach copy of the organization’s W-9 form: Upload: Choose file

Attach any other relevant files: Upload: Choose file

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