Sponsorship Agreement

Company Name: _________________________________________
Address: _______________________________________ ______________________________________________ ______________________________________________
Telephone: ___________
Contact Name: __________________
Contact Telephone: ____________

Sponsorship Package (Check Appropriate Box)

Feature Section
Year One $1,500: ___
Year Two $500: ___
Name of Section: ________________________________
Please Send Invoice: ___

Authorization:

Signature: _______________________________
Name: ____________________________
Title: ______________________________
Date: ______________________

Please make cheques payable to:
Fowler Kennedy Sport Medicine Clinic

Return this application to:
R. Furlong
Fowler Kennedy Sport Medicine Clinic,
3M Centre,
The University of Western Ontario
London, Ontario
N6A 3K7

Your support of the Fowler Kennedy Sport Medicine Clinic is sincerely appreciated.