Donation Request Form Page 1 Finish Donation Request Form Today's Date Date First Name Last Name Organization 501C3 Number * Address P.O. Box/Apt # * City * State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington D.C.West VirginiaWisconsinWyomingPuerto RicoUS Virgin IslandsArmed Forces AmericasArmed Forces PacificArmed Forces EuropeNorthern Mariana IslandsMarshall IslandsAmerican SamoaFederated States of MicronesiaGuamPalauAlberta, CanadaBritish Columbia, CanadaManitoba, CanadaNew Brunswick, CanadaNewfoundland, CanadaNova Scotia, CanadaNorthwest Territories, CanadaNunavut, CanadaOntario, CanadaPrince Edward Island, CanadaQuebec, CanadaSaskatchewan, CanadaYukon Territory, Canada * Zip Code Phone Email Has your organization purchased advertising with The Times this year? None Yes If not, are there plans to purchase? None Yes No Who is your sales rep? Sponsorship/Event Info Please describe the event, sponsorship or in-kind trade advertising you are requesting: * Description You have 500 words remaining. When is event or sponsorship date? Additional Info What benefits (please be specific, i.e. tickets, logo recognition) will The Times receive from this sponsorship? Description Other media involved: Amount of sponsorship being requested? Verify and Submit CAPTCHA
