CORPORATE SPONSORSHIPS APPLICATION Complete the application by filling in each of the entry fields. Any field with an * is required. When the application is complete, click the SUBMIT button. Who is your primary contact at Upsher-Smith?Who is your secondary contact at Upsher-Smith?Your Contact InformationContact InformationOrganization Name*Contact Name* First Last Contact Title*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Business Phone Extension (if applicable)Cell PhoneWebsite Email* Enter Email Confirm Email Organization's Status*Non-ProfitCorporationIndividualEvent Information (if applicable)Event InformationEvent nameEvent date** / Event date start (if multiple days)** **Events can only be processed if dates are provided.Event date end (if multiple days) Event CityEvent StateEstimated number of event participantsSponsorship InformationSponsorship InformationPlease upload your W9 here. Include any other necessary attachments. Drop files here or Accepted file types: doc, docx, pdf. Word and PDF files only, pleaseSponsorship Request Description and SpecificsSponsorship Level Requested (in US dollars)NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.