CPSA Community Relations Sponsorship Form - College of Physicians & Surgeons of Alberta

CPSA requires completed application forms to be submitted a minimum of 60 before the date of the event or project. If all information has been provided, you will receive a response from CPSA within 30 days of submitting your application. CPSA only sponsors organizations/initiatives that meet the following criteria: • CPSA is directly involved in the event: • is a partner in developing/coordinate the event, or • is providing a speaker, or • is hosting a display, etc. OR • The event is in Alberta and will provide a direct and obvious educational benefit to Alberta-based physicians, medical students and/or medical residents.

Contact Information
Name*
First Last
Name of organization*
Phone*
Email*
Enter Email Confirm Email
Mailing address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
About Your Organization/Event
Date of event
YYYY slash MM slash DD
Time of event

: Hours

Minutes

AM/PM
Location of event
Name of venue Street address City Province Postal Code
Brief description of your organization:
What are the goals/objectives of this event?
What is the purpose of the event you are planning?
Who is the intended audience for this event?
- Physicians
- Healthcare workerss
- Medical residents
- Medical students
- Albertans/the public
- Other
If other, please identify who the audience is and their knowledge of CPSA
What is the audience size?
How much funding are you requesting?
In addition to CPSA's Terms of Sponsorship (outlined below) how will CPSA be recognized if we support your request?
Terms of Sponsorship
As a representative of the organization seeking funding named above, I will ensure CPSA is appropriately recognized for its sponsorship contributions by providing a written summary of the event within 30 days. This summary will include the following:*
• participant evaluation of the event (survey)
• photographic evidence of CPSA's logo at the event
• supporting documentation such as newsletter and/or media coverage
• copies of event programs and/or agendas
I agree to the terms of sponsorship
Full name of representative*
First Last
Date*
YYYY slash MM slash DD
Comments
This field is for validation purposes and should be left unchanged.

Contact Information

About Your Organization/Event

Terms of Sponsorship

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