*1.Please Share Your Company's Info:(Required.)

Name: *

Company: *

Address:

Address 2:

City/Town:

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:

*2.Please Select Your Sponsorship Level by Telling Us How Much Your Tax Deductible Donation Will Be:(Required.)

UNDERWRITER LEVEL | Donation of $20000 or more by Walk Date = We'll Thank You with Your Logo on The Walk Website, Walk Newsletters, Sign at the Walk, Opportunity for Table at the Event*, and thank you in announcements during the event! Your Donation is a Tax Deductible Way to Support Suicide Prevention!

BENEFACTOR LEVEL | Donation of $10000 - $19999 by Walk Date = We'll Thank You with Your Logo on The Walk Website, Walk Newsletters, Sign at the Walk, and Opportunity for Table at the Event*! 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 Walk Website,Walk Newsletters, and Sign at the Walk! 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 Walk Website, and in Walk 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 Walk Website, Newsletter, and a sponsor sign sent to you before the walk! 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 Walk Website! Your Donation is a Tax Deductible Way to Support Suicide Prevention!

*3.Donation Submission Method:(Required.)

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 First St, #150, Highland Park, IL 60035

Via Online General Chicagoland Walk Donation at www.ChicagoWalk.org

Please Process The Following Credit or Debit Card (Include Donation Amount, Expiration, and Code)

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 rjervis@AFSP.org.

5.Who can we thank for telling you about this sponsorship opportunity?

Rachelle Jervis, Director

eNewsletter sent from Chicago@AFSP.org

Twitter

Facebook

LinkedIn

www.ChicagoWalk.org

Other (please specify)

*6.Have you submitted your logo for the walk tshirts, website, etc yet?(Required.)

Yes, I sent it to rjervis@AFSP.org.

Not yet.

I do not have a logo. Please list my company's name.

Other (please specify)

7.What is the website URL you would like your logo linked to:

8.Thank you for your support!
Is there anything else you'd like us to know?

9.Notes (For Internal Purposes Only)