Lasting Memory Scholarship Program Sponsor and Grant Registration

Today's Date * +

Type of Sponsor

Are you a Provider or a Sponsor?

Select Type of Entity: *

Interested in providing Lasting Memory Scholarship Program as a Provider

Interest in being a supporting Sponsor of the Lasting Memory Scholarhsip Program

A Provider is involved in organizing or funding a Lasting Menorey Scholarship Program for family members, suchas a funeral home. A Sponsor supports the overall concept and development of the Lasting Memory Scholarhip Program as a service with a financial grant, but does not get involved in contribution funding of a specific scholarship program.

Type of Lasting Memory Scholarship Program Providerr *

Funeral Home Provider

Company or Organization Provider

Individual Provider

Type of Lasting Memory Scholarship Grant Sponsor *

Company Sponsor

Organization Sponsor

Type of Company or Organization *

First Name *

Last Name *

Title *

Company or Organization Name (if applicable or indicate "None") *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Website *

Tax Deductibility

Sponsor Grants and both Provider Contributions and Contributor donations may be tax deductible. Check with your attorney, or accountant.

Registration and Grant Proposal

Company Sponsor Grant *

Bronze ($5,000.00)	Silver ($10,000.00)
Gold ($25,00.00)	Platinum ($50,000.00)

Sponsors are listed in brochure and forms

Registration and Grant Proposal

Upon completion of Registration you will receive a grant proposal for sponsoring a Lasting Memory Scholarship Fund

Registration (Read Below) *

Yes

No

By registering as a Sponsor, you agree to to share your contact information with the users and consent to receive email and direct mail communications from users and us. To stop communications please refer to our opt-out procedures provided in any future e-mail or direct mail communication.

We are not providing financial, investment or insurance advice; nor are we solicting investment or insurance business. We are not responsible for the opinion or business practices of any of the companies listed in the directory and their opinion is soley their own views on subject matter.

Upon approval of registration you will be billed the annual $500 fee.

Authorization (Write signature with your mouse below) *

clear

Payment

Payment should be sent to:

Lasting Memory Organization

Payment Processing

162 Campus Drive

Cobleskill, NY 12043

Bank	Retail
Transportation	Insurance
Life Insurance Company	Private Equity, Hedge Fund, Venture Capital
Technology	Professional or Legal
Not for Profit	Manufacturing
Other (please specify) Other (please specify)