Radius Sponsorship Form
This form is not intended to be used for the following:
•
•
Medical Educational Grants
Charitable Contributions
Submission Checklist/Required Documents
 Signed Sponsorship Form
 Brochure (documentation from requesting Organization (e.g., brochure, formal letter/invitation,
meeting agenda, conference schedule)
 Defined Benefits to Radius (documentation that lists the specific benefits to Radius for the level
of funding requested)
 Proof of tax exempt 501(c) status
 Completed W-9 (W-8 for ex-US applicants)
 Completed New Vendor Authorization & Change Request Form
Please send this Application and all required documents to [email protected] at least 60
days prior to the event.
Legal Name of Organization:
Organization Mailing Address:
Organization Email:
Organization Telephone:
Organization Website:
Authorized Representative of Organization:
Email:
Event Name:
Amount Requested (Currency):
Event Date(s):
Event Location (City/State)
Event Venue (include name and address)
Sponsorship Form
Phone:
Is the Organization tax-exempt as defined by the
IRS?
 Yes
 No
Tax ID Number:
Purpose (e.g.,
fundraising, disease
awareness)
Indicate Type of Request:
 Sponsorship
 Corporate Membership
 Other (describe)
Other:
Indicate the tangible commercial benefit that Radius will receive as a benefit of this funding:
 Exhibit or booth opportunity
 Banner at a conference
 Advertising space on a printed brochure or website
 Tickets to an Event
 Corporate Membership in an organization
 Other (please describe)
To be completed by Radius Owner:
Complete if this Sponsorship includes an Exhibit or Display:
 Exhibit opportunity is available to other companies – the request is a general solicitation (e.g., the
same price is offered to other companies).
 If the event includes an educational program, the exhibit booth space is separate from the education
space.
 All materials and signage to be used in the Radius exhibit booth will be or have been approved by the
appropriate Radius Review Committee or Legal.
 If product materials will be shown for products not currently approved in the host country, will signage
be available at the Radius booth to note this to attendees?
 Yes
 No
 If PRC-approved Educational Items will be provided to HCPs at the Exhibit or Display, will Radius
signage/mechanisms be in place to prohibit the provision of Educational Items to HCPs from certain
states, e.g., Vermont?
Global Sponsorships, Exhibits & Corporate Membership Form
To the best of my knowledge, the information I have provided in this document is complete and accurate. I confirm that
a legitimate business need exists. I confirm that this activity will be conducted as described above and in accordance
with applicable local, regional laws and industry codes, including Radius Compliance Policies. I understand that certain
states have specific limitations or prohibitions that I am responsible for understanding and following.
Name
Radius
Owner
Signature
Department/Function
Date
Cost Center
Radius Department that will fund the approved Sponsorship is responsible for:
 Coordinating with the Legal Department to obtain a written agreement between Radius and the
Sponsorship recipient. (NOTE: A written agreement must be executed by Radius and the requestor
prior to the release of funds.)
Radius Reviewers
Function
Name
Signature
VP of
Requesting
Function
Date
Amount
Approved
Denied

Corporate
Affairs

Legal

Global Sponsorships, Exhibits & Corporate Membership Form