2018 Community Health Summit: Working Together for a Healthier Connecticut

SPONSORSHIP FORM

You are invited to participate as a sponsor for the 2018 Community Health Summit. This event will provide training and networking opportunities to Connecticut's 17 Federally Qualified Health Centers, government and elected officials, and CHCACT's partners and stakeholders. The Summit will take place on, September 14th 2018, at the Toyota Oakdale Theatre in Wallingford, CT. Expected attendance at the event ranges from 200-250 attendees.

To become a sponsor of the 2018 Community Health Summit, please complete the Event Sponsorship Form below.

If you have any questions, please contact Luci Goodwin via email (lgoodwin@chcact.org) or phone (860-667-7820 ext. 316).

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* 1. Sponsoring Company/Organization (as you would like it listed on event materials):

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* 2. Sponsor Information:

Street Address:

City, State:

Zip/Postal Code:

Company/Organization Phone Number:

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* 3. Donation Amount:

Friend of CHCACT: $100

Level One: $750

Level Two: $1,500

Level Three: $2,500

Level Four: $3,500

Level Five: $5,000

Level Six: $10,000

Other (please specify)

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* 4. Contact Person:

First & Last Name

Title

Phone Number

Email Address

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* 5. Will you require a display table during the event?

Yes

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* 6. If you will have a display table, will you require access to an outlet?

Yes

Checks should be made payable to the Community Health Center Association of Connecticut and mailed to:

Community Health Center Association of Connecticut
1484 Highland Ave, Suite 2
Cheshire, CT 06410

Your sponsorship is tax-deductible to the extent allowable under IRS 501(c)(3) regulations; ; the amount of the contribution considered deductible for federal income tax purposes is limited to the excess of money (and the fair market value of property other than money) contributed above and beyond the value of goods or services provided.