Sponsorship Request Form

Thank you for considering Neighborhood Health Plan of Rhode Island to support your mission. Neighborhood is proud to support community organizations that improve the health of Rhode Islanders. Please complete this form to submit a request for event sponsorship, program support, or general support. Form fields with an asterisk (*) are required. It may take up to several weeks for your request to be reviewed.

Name of Organization*

(This must match the name on your W9)

Event Name*

Contact Information

Name*

First Last

Title*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

(This must match the address on your W9)

Email*

Check Payable to*

(This must match the name on your W9)

Event Information

Date of Event*

Time of Event*

Location of Event*

Address of Event*

Street Address Address Line 2 City State ZIP Code

Upload Sponsorship Package*

Accepted file types: doc, docx, jpg, jpeg, pdf, Max. file size: 10 MB.

Upload doc, docx, jpg, jpeg, pdf. If your sponsorship package includes an ad, please include the ad sizes (width x height) in your request.

Upload W9*

Accepted file types: doc, docx, jpg, jpeg, pdf, Max. file size: 10 MB.

Upload doc, docx, jpg, jpeg, pdf

Upload EFT*

Accepted file types: doc, docx, dotx, jpg, jpeg, pdf, Max. file size: 10 MB.

Upload doc, docx, dotx, jpg, jpeg, pdf

EFT Payment Enrollment Form

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