Sponsorship & Donation Request
Are you a current patient?
If no, please indicate when treatment was completed:
Name of Organization/Event for sponsorship:
Sponsorship Due Date:
Who will benefit from this sponsorship:
Please list any patient(s) of Koch Orthodontics related to this sponsorship:
If artwork is requested/required, where will this be featured?
How will this sponsorship make a difference in your life?
Have you requested a sponsorship or donation for this organization before?
Please upload all supporting documents related to this request.
Please allow 10 business days for a response.