PSAI Urgent Run/Walk
SPONSORSHIP REQUEST FORM
Note: The Urgent Run/Walk will be moved indoors and adjustments will
be made to your visibility package in the event of inclement weather.
Company Name: __________________________________________________________________________
Address: _________________________________________________________________________________
City: _____________________________ State/Province: ____________ Zip/Postal Code: _____________
Company Email: ___________________________________ Company Phone:________________________
Total Amount Due: ___________________
*Please call the PSAI office if you need assistance determining your total
My check is enclosed OR please charge total amount to: ___ VISA ___ MASTERCARD ___ AMEX
Cardholder Signature: ___________________________________________________________________________________
Cardholder Name (Please Print): __________________________________________________________________________
Card Number: ________________________________________________ Exp. Date: ________________ CSC: __________
SPONSORSHIP PACKAGES
Yes, my company would like to sponsor the 2017 Urgent Run, and would like to select the
following package:
CHAMPION
$1500
PROMOTER
$1000
ADVOCATE
$750
SUPPORTER
$400
FRIEND
$250
COMPLIMENTARY PARTICIPANTS
I have selected the ____________________ package, which includes _____________ complimentary
registrations for the 2017 Urgent Run. Below are the names of those who will fill these registrations
for my company's team.
1.
2.
4. 3.
5. 6.
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