Exit this survey Race AFSP Sponsorship Form Question Title * 1. Please Share Your Company's Information: Name: * Company: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: * Question Title * 2. Please Select Your Sponsorship Level by Telling Us How Much Your Tax Deductible Donation Will Be: BENEFACTOR LEVEL | Donation of $10000 or more by Walk Date = We'll Thank You with Your Logo on The Race Team Website, Race Newsletters, Sign at the Bank of America Chicago Marathon AFSP Illinois Tent, and Opportunity for Your Materials at Our Tent*! Your Donation is a Tax Deductible Way to Support Suicide Prevention! PLATINUM LEVEL | Donation of $5000-$9999 by Walk Date = We'll Thank You with Your Logo on The Race Team Website, Race Newsletters, and Sign at the Race Team Tent! Your Donation is a Tax Deductible Way to Support Suicide Prevention! GOLD LEVEL | Donation of $1000-$4999 by Walk Date = We'll Thank You with Your Logo on The Race Team Website, and in Race Newsletters! Your Donation is a Tax Deductible Way to Support Suicide Prevention! SILVER LEVEL | Donation of $500-$999 by Walk Date = We'll Thank You with Your Logo on The Race Team Website and Race Newsletter! Your Donation is a Tax Deductible Way to Support Suicide Prevention! BRONZE LEVEL | Donation of $250-$499 by Walk Date = We'll Thank You with Your Logo on The Race Team Website! Your Donation is a Tax Deductible Way to Support Suicide Prevention! Question Title * 3. Donation Submission Method: Via Credit Card Number I have/will send to Rachelle Jervis, MBA, Illinois Area Director Via Check I have/will send to AFSP at 1954 1st Street, # 150, Highland Park, IL 60035 Via Online General Walk Donation on the Race Teams's Website (www.RaceAFSP.org) Please Process The Following Credit or Debit Card (Include Donation Amount): Question Title * 4. Do you require an invoice (in addition to the donation receipt we provide everyone) to process your donation? Yes. No. At this time I do not. However if I do in the future I will email Rachelle Jervis at rjervis@AFSP.org. Question Title * 5. Have you submitted your logo yet? Yes, I sent it to Rachelle Jervis at rjervis@AFSP.org in png, jpg, or pdf format. Not yet. I do not have a logo. Please list my company's name. Other (please specify) Question Title * 6. Thank you for your support! Is there anything else you'd like us to know? Done
