1 Organization Information2 Donation Details3 Event Details4 Sponsorship Benefits5 Signature Organization Name*Does your organization have a 501(c)3 status?*YesNoContact Person*Email* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*What is your website?Are you a current Blackfoot customer?YesNo Donation DetailsNext, tell us a bit more about your donation request.What is the purpose of your request?*Event Date(s) and Time*Event Location*What is the donation amount requested?*What is the deadline for sponsorship commitment?*Who should the check be made payable to?*How will the donation be used?*Has Blackfoot sponsored this event before?*YesNoPlease describe who directly benefits from the donation requested.Will this donation be matched with other funds or sponsors (what level)? Event DetailsTell us a bit more about your event.Describe your event.What is your expected attendance?Is this a fundraiser?YesNoIs the event open to the public?YesNo Sponsorship BenefitsPlease provide information regarding how Blackfoot will be recognized for our support.Optional: Upload sponsorship benefit information.Upload any sponsorship materials here, such as information on different levels and benefits. Note: You may only upload one file, so please combine all documents into one PDF.Accepted file types: pdf.What are the sponsorship benefits?Please check all that apply. Banner placement Logo on website Social media mentions Print advertisement in program Verbal recognition at event Printed recognition Event tickets Other Where will the banner be displayed? Indoors Outdoors What size banner will work? Small banner Large banner Free standing signage What social media do you plan to use?Please include a link to your social media profile, such as your Facebook page.What is the size of the ad?What is the deadline for the ad?Who should we contact regarding the ad? Is there an event emcee?Can Blackfoot provide a script for the announcements? Or will our name simply be mentioned?Where will Blackfoot's name/logo be printed?How many tickets are provided?Please describe any other sponsorship benefits. Blackfoot Telecommunications Group and Blackfoot Telephone Cooperative reserve the right to deny any request or honor a partial amount of the request without stating any reasons. Electronic Signature*Please fill in your name below to electronically sign your application. By doing so, you are acknowledging that you are a representative of the organization, and all information entered on the form is accurate to the best of your knowledge.Date* Upload Proof of Non-Profit Status*You indicated your organization is a non-profit. Please upload documentation that provides proof of your 501(c)3 status.Upload Your W-9If funding is approved, a completed Request for Taxpayer Identification Number and Certification (IRS Form W-9) will be required. You can upload and submit your W-9 now to expedite your request. If you need the W-9 form, please visit http://www.irs.gov/pub/irs-pdf/fw9.pdf. NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.