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Operation-Initiative
Foundation Business and
Organizational Sponsorship Application

Referral Sponsorship Dues

For Profit Businesses
Annual Sponsorship: $250 *

Not For Profit Organizations
Annual Sponsorship: $200 *

Please Make Check Payable To:

The Operation-Initiative Foundation, Inc.

Please Complete and Mail The Sponsorship Application
With Your Check To :

The Operation-Initiative Foundation, Inc.
99 North Broadway
Hicksville, New York 11801

The annual sponsorship dues contain a one-time nonrefundable vetting and administrative fee of $30.
Upon receipt of an applicant’s completed application and sponsorship fee, a copy of The Operation-
Initiative Foundation, Inc.’s Vetting Form will be e-mailed to the applicant. In the case where a
business’s or organization’s sponsorship application is not approved, the annual sponsorship will be
refunded to the applicant.

Name of Business or Organization:
Date:
Business or Organization Postal Address
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
Business Details
Is The Business or Organization
(Check One Of The Following):
Name of Individual Representing Business or Organization::
Position at Business or Organization:
E-Mail Address:
If Different From Above
Telephone Number:
Fax:
 
Is The Person Listed Above Licensed and/or Certified To Practice His or Her Specialty In The State of New York?:

If the Answer To The Above Question Is “Yes”, Please List The Specialty In Which You Are Licensed and/or Certified to Practice in The State of New York. License and/or Certification:
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