Moore and Company

Box 460, Balzac, AB

                                    (403) 226-2585 (phone), (403) 226-1381 (fax)

                                    www.mooreandco.com

                                 Sponsorship Request Form

*Please allow 60 (sixty) days notice to process; Upon completion of this

                              form, please fax to (403) 226-1381, Attn: Krystin Helgren**

Current Date:       _____________________________________________

Name of Event:     _____________________________________________

Date of Event:       _____________________________________________

Contact Person:    _____________________________________________

Phone Number:    _____________________________________________

Email Address:     _____________________________________________

Brief Description of Event: ___________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Sponsorship Requested (ie - monetary sponsorship, first aid kits, veterinary services, etc.):___________________________________________________

________________________________________________________________________________________________________________________

Has Moore and Company previously sponsored this event?  Y / N

If yes, what date and sponsorship was requested? __________________________________________________________________________________