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About
Mission & Purpose
The Building Blocks
Community Impact
Privacy Policy
Our Staff
Resources
Wellness Workshops
Tools & Materials
Donate
Contact
PREMIUM PARTNER DONATION FORM
Submit this form for annual contributions in the amount of $10,000 & up.
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Organization Name
Primary Contact
*
First
Last
Email
*
Phone
*
Mailing Address
*
Address Line 1
Address Line 2
City
South Carolina
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Website / URL
Facebook Link (if applicable)
Instagram User Name (if applicable)
LinkedIn Profile link (if applicable)
Please indicate your preferred partnership Level:
Premium Partnerships
Gold Level 2 - $ 75,000.00
Gold Level 1 - $ 60,000.00
Silver Level 2 - $ 45,000.00
Silver Level 1 - $ 25,000.00
Bronze Level 2 - $ 18,000.00
Bronze Level 1 - $ 12,000.00
Please upload a high resolution version of your organization's logo.
Click or drag a file to this area to upload.
Authorized Signature
Clear Signature
Total
$ 0.00
SUBMIT