2023 SPONSORSHIP FORM

SPONSORSHIP
Date*

MonthDayYear
Date
Name of Sponsor*
Email*
example@example.com
Name of Contact Person*
Email*
example@example.com
Address/ City/ State/ ZIP*
Office Phone*
Cell Phone*
Sponsor’s Name exactly as it should appear in all event publications*
I/We do not wish to be listed in event publications
Sponsorships Available

Team Number One ($20,000)Pit Stop ($10,000)Express Pass ($5,000)Speed Bump ($2,500)U-Turn ($1,250)Clue Box *New PediPlace Sponsors Only* ($500)
Get ahead of the game and pre-purchase your boost and mulligan pack! Boosts can be used to make an activity easier and Mulligans allow you to skip an activity.

Add the Boost and Mulligan Pack: 1 Boost per site and 1 Mulligan for your site of choice ($200)
I AM UNABLE TO ATTEND, BUT WISH TO MAKE A CONTRIBUTION IN THE AMOUNT OF:
Donations $100 and above will be recognized in the event program. Payment is requested by 3/20/2023.
Billing and Payment Information

Invoice me at the above addressI sent/will send a check payable to PediPlacePlease charge my card
Calculation

Card Type
I hereby authorize PediPlace to charge my credit card in the amount of ${calculation}.

Clear
Please return completed underwriting contract by March 1, 2023 to:

PediPlace Attn: Shari Markey 502 S. Old Orchard Lane #126 Lewisville, TX 75067

shari.markey@pediplace.org

469-322-3660

Your contribution is tax deductible to the extent allowable by law. PediPlace sincerely thanks you for your support.
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