Charitable Giving Request Form

Oganization*
Amount Requested*
Geographic Location*
Purpose*
Address*
Street Address Address Line 2 City State ZIP Code
Contact Person*
Phone*
Email*
Website Address
Date of Event*
MM slash DD slash YYYY
Marketing/Print Deadline*
MM slash DD slash YYYY
How does this project relate to health care issues and/or promote good health in Maine or Northern New England?
If fundraising event, please give a brief description of the function and number of people projected to attend
Recognition Spectrum will receive as a sponsor
Reasons why Spectrum should support this project

324 Gannett Drive, Suite 200
S. Portland, Maine 04106
Phone: 207.482.7800
For billing questions,
click here
6 State Street, Suite 611
Bangor, Maine 04401
For billing questions,
click here