Submitted by dev-admin on Tue, 04/23/2019 - 09:51 Mix Maine Media makes every effort to help our surrounding communities and support the residents who live and work in Central Maine, allowing us to continue to fulfill our mission to work to better the communities and lives we have been entrusted to serve through the use of entertaining and quality media products and services.Please fill out the following information completely. Business/Organization Information Name of business/organization * Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Contact Name * Contact Phone * Contact Email * Sponsorship Request Information Amount/type of sponsorship requested * Date Needed By Have you received sponsorship from us in the past? * - Select -YesNoI'm not sure Will Mix Maine Media receive publicity in recognition? * - Select -YesNo If so, in what form? Brief description of the request and how the donation will be used * Is there anything else you would like to include or clarify? CAPTCHA This lets us know that you're human. Math question * 1 + 13 = Submit
