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Corporate Sponsorship Request Form (NEW)

Charitable Guidelines: Arkansas Blue Cross Blue Shield is a proud supporter of our local community. For donation consideration, please fill out this form in its entirety and include 501(c)(3) tax id number. Completion of this form does not guarantee a donation. Arkansas Blue Cross Blue Shield Donations are solely awarded at the Corporate Contributions Committee's discretion.

When you encounter a question in the survey that you are unable to answer, please indicate "Not available" in the required fields.
1.Organization's Name(Required.)
2.Organization's Mailing Address(Required.)
3.EIN #
4.Organization Contact (First and Last)(Required.)
5.Title(Required.)
6.Email Address(Required.)
7.Contact Number(Required.)
8.Organization's Website
9.Please inform us how you learned about the Arkansas Blue Cross and Blue Shield sponsorship opportunity. If an ABCBS employee referred you, please provide their name.(Required.)
10.When is the deadline for responding to this request?(Required.)
11.What initiatives and programs will benefit from this request ?(Required.)
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