WGA Sponsorship Request Form

West Georgia Ambulance is invested in the communities we serve. Through sponsorship, we support events held by local companies, civic groups and organizations.

Organizations seeking sponsorship funds should fill out and submit the form below. We require at least six weeks’ notice to consider and properly evaluate each sponsorship request. Due to numerous requests and limited sponsorship funds, we cannot accommodate every request.

Please fill out the WGA Sponsorship Request Form to apply for a sponsorship.

First Name

Last Name

Telephone

Address1

Address2

City

State

Zip

Inquiring Sponsor Organization Name:

Organization Address:

Organization City:

Organization State:

Organization Zip:

Organization Website:

Is your organization a 501 (c)(3)?

YesNo

Sponsorship Amount Requested:

Sponsorship Event Name:

Sponsorship Event Description

Does your organization/event encourage a healthy community?

YesNo

Is your organization/event dedicated to community development?

YesNo

What is the mission of your organization/event?

Does your event provide the community with educational or life-saving information?

YesNo

What organization, group or person benefits from the funds raised at your event?

Date of event to be sponsored:

Whom do you expect to attend the event?

What is the location (city, state and county) of the event?

What benefits will West Georgia Ambulance receive from the sponsorship?

What is the cost of the sponsorship (including levels)?

If there is no monetary cost, what is required for the sponsorship?

What type of media, print, radio, web or social exposure is expected for this event?

What other sponsors have committed (to date) to support this event? (If unknown, indicate the number of sponsors anticipated.)

How many people do you expect to reach and influence with this event?

Please provide any history for this event to demonstrate past effectiveness and reach:

SUBMIT