Exit this survey Sponsorship of Out of the Darkness Chicagoland Walk Question Title * 1. Please Share Your Company's Info: 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: 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! 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 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) 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 rjervis@AFSP.org. Question Title * 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) Question Title * 6. Have you submitted your logo for the walk tshirts, website, etc yet? 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) Question Title * 7. What is the website URL you would like your logo linked to: Question Title * 8. Thank you for your support! Is there anything else you'd like us to know? Question Title * 9. Notes (For Internal Purposes Only) Submit!