Sponsorship - Humanitarian Donation Form

Member application for financial assistance for personal participation in a recognized humanitarian effort, request for charitable donation, and/or sponsorship donation.

Note: All requests must be submitted no later than 30 days prior to the start of the event.

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* Indicates required field

Full Name *

Member Number *

Employer/Work site *

Discipline *

Home Address *

Postal Code *

Home Telephone *

Personal Email *

Date of project/event *

Name of project/event *

Have you previously received sponsorship funding from HSAA? *

Yes

If yes, when?

Description *

Describe the humanitarian effort, purposes to which a charitable donation will be put and/or details of sponsorship request.

Describe what your expected role will be, how HSAA’s financial support will be acknowledged, and how you will report back to HSAA once your participation is concluded. (If you require more space, please indicate attachments.)

Attachments

One file only.
64 MB limit.
Allowed types: jpg jpeg png txt rtf odf pdf doc docx ppt pptx xls xlsx odg odp ods odt fodt fods fodp fodg key numbers pages.

Charitable Organization *

Amount Requested *

Authorization Signature *

Sign below by drawing with your mouse or finger: