□ Yes, our company would like to be a Corporate Supporter of the Nebraska Rural Health Association at the following level:
□ PLATINUM SPONSOR………..$3,500□ GOLD SPONSOR………………$3,000□ SILVER SPONSOR………….$2,500□ BRONZE SPONSOR………..$2,000Company: ________________________________________________________
Contact Person: ____________________________________________________
Telephone: ________________________________________________________
E-Mail:___________________________________________________________
Address: ___________________________________________________________
City: _____________________State:______________Zip:____________________
□ Please contact me to discuss the sponsorship packages in more detail
Please make checks payable to:
Nebraska Rural Health Association
2222 Stone Creek Loop South
Lincoln, NE 68512
Nebraska Rural Health Association
Corporate Sponsor Application
