Community Sponsorship/Event Request

Submit your request online:

Fill out the information below to request an AtlantiCare sponsorship.

Items with an asterisk (*) are mandatory.

Types of Request (Check all that apply): *
Name of Organization: *
Address: *


City: *
County: *
State: *
Zipcode: *
Website:
Is your organization a registered 501c3, or 501c4? *
Please indicate the key area your event/program/organization supports: *
Please describe your request in more detail Including how it aligns with the key areas: *
Has AtlantiCare supported this initiative in the past? *
Did an Atlanticare team member encourage you to apply? If so, please share the name of the team member and connection to your organization? *
Event Name: *
 
Date of the event: *
  
Does this event honor someone? If so, enter name:
 
Target Audience: *
Expected Attendence: *
Contact Name: *
Contact Phone: *
Contact Extension:
Contact email: *
Submitted by (if other than point of contact):
File Upload(s):