Donations/Sponsorship Requests

In-Shape is active in the communities we serve. Organizations requesting membership or other donations/sponsorships can fill out the form below and submit it to In-Shape's corporate office for consideration. Please provide at least 30 days notice for any event.

All fields with "*" are required. Only one request per organization per calendar year. All donations will be mailed to the address listed on the request unless otherwise indicated. You can also fax information to 209-474-7586, Attention: Donation Requests.

Organization Name: *

Address: *

City: *

State: * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip: *

Tax ID:

Contact Name: *

Contact Phone: *

Contact Email: *

Event Date: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20112012201320142015

ITEM REQUESTED & EVENT DESCRIPTION: (What and how will the donation be used?): *

Date Needed (Allow 30 days):

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20112012201320142015

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Enter the characters shown in the image.