Oneida Indian Nation

2010-02-18
Cookhouse
10:00 am
2:00 pm

Upstate Medical University

2010-02-17
Weiskotten Hall 9th Floor
Noon
2:00 pm

OCC

2010-02-12
Gordon Center Great Room
11:00 am
4:00 pm

NSBE

2010-02-08
S.U. Schine Student Center Room 302 ABC
11:30 am
2:30 pm

OCC

2010-01-08
Gordon Center Great Room
11:00 am
1:00 pm

Onondaga Nation Arena

2010-01-05
326 Route 11 Onondaga Nation
10:00 am
2:00 pm

William G. Pomeroy Foundation


Request for Drive

Thank you for joining our national initiative to diversity the Be The Match Registry. Growing the Registry is the key to saving more lives. Let's work together to ensure that every patient has a chance for a cure. Your organization has the power to make it happen.

Please fill out the form below to request hosting a drive in your community. If you have any questions, feel free to contact Paula Miller at (315) 476-3000 ext. 2520.

Event Request Form

ORGANIZATION:

Contact Info:
Name
Address 1
Address 2
City
State
Zip
Phone
Web Address
Name
Address 1
Address 2
City
State
Zip
Phone
Email



Event Info:

Promotional Materials:
Name
Address 1
Address 2
City
State
Zip
Web Address
Date
Time
Expected #
of attendees
Short Description
Flyers:
How many
Date Needed
Shipping Address 1
Shipping Address 2
City
State
Zip
Sample Press Release Yes | No
Sample Public Service Announcement Yes | No
Is there a local patient involved?

If yes, publicity release form must be signed by patient/legal guardian. Please provide patient photo for flyers to pmiller@cxtec.com

FEES NEEDED:
There are occasions when it is necessary to pay for booth space, etc... As a non-profit organization, we always request donated space, tables, chairs, etc…or we supply our own if applicable.

However, if you seek funds to conduct your drive, please indicate below. You will receive approval based on the type of event and fees required.

Amount Requested
Expense Budget
Payee Name
Address 1
Address 2
City
State
Zip
Date Check Needed