Language
English (US)
Sponsorship Request Form
Please fill out the form below to request a sponsorship or donation from one of our cancer centers. We request that you upload the sponsorship packet and any information that needs to be filled out at the bottom of this form.
DateTime
Your Name
*
First Name
Last Name
Your E-mail
*
example@example.com
Is this request a sponsorship or a donation?
*
Sponsorship
Donation
Unsure
Which center are you requesting a sponsorship or donation from?
*
Please Select
Eastern Oregon Cancer Center at Pendleton
Northeastern Oklahoma Cancer Institute - Claremore
Anchorage Radiation Oncology Center
Mat-Su Valley Cancer Center
Peninsula Radiation Oncology Center
Southeast Radiation Oncology Center
Requesting Organization Name
*
Requesting Organization Contact
*
First Name
Last Name
Requesting Organization Contact Email
*
example@example.com
Organization Address to send check:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Sponsorship Amount Requested ($)
*
$200
Date Needed By
*
-
Month
-
Day
Year
Date
Upload sponsorship request form or brochure
*
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