Funding Application

* Indicates a required field

Name of Organization/Group

Contact First Name

Contact Last Name

Organization Street Address

City

State

Postal Code

Phone

Briefly describe your organization's goals and objectives:

What communities and/or individuals will benifit from a contribution from Premier?

How will they Benefit?

Are you an Approved 501(c)(3) status organization?*

Yes

Amount/type of contribution or donation are you requesting?*

If seeking advertising sponsorship, how man recieve the publication?

Please list ad sizes for advertising, if applicable:

As a local advertiser, we can respect deadlines. Please let us know when you need confirmation to this request:

Is any artwork required?

If yes, when is the deadline to receive it?

Please provide any additional information that may be helpful as we consider your request: