Application for Sponsorship

Back to Who we support

First name

Last name

Phone

Individual or group name

Name of individual or group seeking sponsorship

Location of individual or group

Location of individual or group seeking sponsorship

Relationship to Queensland X-Ray

Do you or anyone you know, work at Queensland X-Ray? If so, who?

Which category does your request for sponsorship fall into?

Funds

In-kind support

What kind of support are you seeking? *

Dollar value

What is the dollar value of the support you are seeking?

Support period

Over what period are you seeking support?

What will the support be used for?

Support outcome

Will the support help achieve a health and wellbeing OR environmental and sustainable outcome? Please provide detail.

Material evidence

What material evidence can you provide to demonstrate application of sponsorship? (eg images, letters, videos and testimonials)

Is there anything else you'd like to add?

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