Background Information

Name of Group/Company Planning Event *

Contact Person *

Contact Person's Title *

Mailing Address *

1000

Email *

Telephone *

Website

Fax

Please indicate the category that best describes your group *

Promotional Materials

All logos of WellSpan Health and its entities are registered trademarks, the use of which is restricted. In keeping with industry standards, WellSpan Health will only permit use of its logo to those organizations that have a substantial, established relationship with the organization. In those cases, any use of the WellSpan Health logo or name for the proposed event must be approved by WellSpan Health prior to being printed and/or released.

Please note that while you may possess a copy of the logo from a previous initiative, WellSpan Health must approve any subsequent usage of the logo.

Printed materials and other information should state the “Proceeds will support the beneficiary”

Public Relations Information

Will you be promoting your event? *

Yes
No

Would you like to have WellSpan Health Staff/Board of Directors participate in your event? *

Yes
No

Which of the following will you be using to publicize your event? *

Internal promotion such as newsletters
Posters/Flyers
Advertisements
Public Service Announcements
Other

How will you use Internal promotions/newsletters to publicize your event?

1000

How will you use Posters/Flyers to publicize your event?

1000

How will you use Advertisements to publicize your event? *

1000

How will you use Public Service Announcements to publicize your event?

1000

What other forms of communication will you be using to publicize your event?

1000

What is the estimated duration of the promotional activities? *

What is your estimated net revenue for this event? *

Terms accepted by:

Signature of Applicant *

Captcha *

Background Information

Event/Fundraising Information

Promotional Materials

Public Relations Information

Terms accepted by: